There are two types of addiction-related craving: one is physical,which is related to withdrawal; and the other is memory-based,consisting of a desire that persists long after withdrawal has beensubdued. A study in the August issue of Alcoholism: Clinical & Experimental Researchcompares craving between pathological gamblers and alcoholics,correlating craving with personality. Results indicate that gamblersand alcoholics have distinctive personality traits that affect theircravings.
"Personality, and temperament in particular, is defined as the usualbasic emotional reactions and preferences towards both external andinternal stimuli," said Hermano Tavares, coordinator of the ImpulseControl Disorder Unit at the University ofSãoPaulo in Brazil, and corresponding author for the study. "Craving isalso defined in terms of the desire to use a drug and previous memoriesof pleasure superimposed upon a negative emotional state. So, bothconcepts involve emotional regulation and motivation. The idea of ourstudy was to investigate if specific personality traits could influencethe craving experience among alcoholics and pathological gamblers,making it stronger, hence rendering more vulnerability to addiction."
Study subjects (49 pathological gamblers, 101 alcoholics) wererecruited from individuals seeking outpatient treatment at communityagencies and a hospital-based treatment center in Calgary, Albertabetween April 2001 and November 2002, as well as through localadvertising. All participants were diagnosed according to Diagnosticand Statistical Manual of Mental Disorders IV criteria, rated theircravings (for either alcohol or gambling), answered a semi-structuredinterview, and completed the Temperament and Character Inventory andBeck Scales for anxiety and depression.
"Both alcohol and gambling craving were directly related to clinicalsymptoms of depression and anxiety, and inversely related to length ofabstinence," said Tavares. "However, alcohol and gambling cravings didnot share temperament roots, pointing to different roles of both onemotional regulation. In other words, our study suggests that peopleturn to either alcohol or gambling for different reasons."
Tavares said that positive emotions and negative emotions are twoseparate, distinct and independent dimensions, possibly regulated bydifferent brain systems. "We found that alcohol craving was based onthe temperament factor responsible for negative emotions," he said."This suggests that those individuals who are especially vulnerable tonegative emotions are the ones who will miss alcohol the most whentrying to abstain. Conversely, gambling craving correlated to thetemperament factor responsible for positive emotions. This suggeststhat those individuals who naturally lack positive emotions and requireintense stimuli to experience elation are the ones who will missgambling the most when trying to abstain."
"Thus, gambling seems to be more of a stimulant and anti-depressionmeasure," added Sheila Blume, former medical director of AddictionPrograms at South Oaks Hospital in Amityville, New York. "Foralcoholics, craving correlated more with anxiety and harm avoidance,which indicates that alcohol is more of an anti-anxiety measure. Ofcourse, these are not exclusive. Alcoholics also drink and cravealcohol while depressed, and gamblers may crave when anxious, but theseare statistical differences that can be helpful in understandingpatients and in treatment planning."
Both Tavares and Blume dismissed the lay notions of "unhappiness" or "sadness" as factors in addiction.
"Unhappiness is too vague a concept," said Tavares. "Clinicallyspeaking, anxiety is regarded as a state of negative emotionality andheightened arousal, while depression is best described as high negativeemotions and low positive emotions. Heightened arousal and low positiveemotions respectively differentiate anxiety from depression, andnegative emotions are shared by both. Alcohol seems to provide alessening of negative emotions and may be used as a 'tool' to deal withtensions and nervousness, that is, anxiety. Gambling seems to act as a'fix' for individuals who are by nature partially deprived of feelingssuch as joy and elation, and require stronger stimuli to achieveemotional equilibrium and counterbalance depression."
"These findings are not dissimilar to the findings of others inthe field with clinical populations," said Blume. "This is not the sameas saying that all addicts have the same 'addictive personality' butthere are some traits that tend to show up in alcoholics, drug addictsand pathological gamblers more strongly than in the general population.What is novel about this study is their correlation of these traits aswell as emotional states with craving. To my knowledge, this has notbeen done before with alcoholics and pathological gamblers."
Tavares added that "it is important to say that not allindividuals with similar personality profiles will develop alcohol orgambling problems, but they may be at greater risk if the environmentdoes not provide the opportunity to learn how to adjust their nature.Being impulsive, prone to negative emotions, or requiring greaterstimulation to attain joy may require special attention as these peoplecould be at risk for a wider variety of addictive behaviors. Perhaps acombination of traits, rather than the identification of an isolatedone, is a better strategy to re-start investigating the validity of the'addictive personality structure,'" he said.
Blume suggested that future research look at the neurological basis ofcraving, as well as the mechanisms of how it works on a basic level."We need better physiological measurements of craving and betteranti-craving strategies," she said.
Alcoholism: Clinical & Experimental Research (ACER) is theofficial journal of the Research Society on Alcoholism and theInternational Society for Biomedical Research on Alcoholism. Co-authorsof the ACER paper, "A Comparison of Craving Between PathologicalGamblers and Alcoholics," were: Monica L. Zilberman of the Departmentof Psychiatry at the University ofSão Paulo; David C. Hodgins of theDepartment of Psychology at the University of Calgary; and Nadyel-Guebaly of the Department of Psychiatry at the University ofCalgary. The study was funded by the Brazilian National Council onResearch and Development, and the Alberta Gaming Research Institute.
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