Workaholism is an addiction to work; it's been called the least recognized & therefore, one of the more dangerous addictions because it often looks like wholesome hard work which is praised & rewarded.

How can you tell the difference? Workaholism as a word should probably be limited to an unhealthy over-involvement with work that results in:

• neglect of the family
• poor relations at work
• absenteeism 
• unproductiveity
• eventual burnout at work 
• health problems due to stress

In such cases, it's obviously a disorder.

There are probably several kinds of workaholics (Killinger, 1997), including the people happily & highly invested in their work ("I love it but the wife doesn't like it & I miss being w/my kids") & employees driven to overwork by fears, threats, perfectionism, compulsiveity, or competition.

The happy 10-hour-a-day person who feels his / her life work is important & has a good family life, meaningful relations at work & with friends, wouldn't be seriously labeled a workaholic. Robinson (1998) describes the unhealthy workaholic personality but in this book mostly discusses dealing with it in Cognitive therapy.

In an earlier book, Robinson (1992) suggests self-help methods for slowing down, deciding what's important in life & re-building strained relationships (see other books below).

• a way "out of the house"
• "a way to make up for your inadequacies & low self-esteem"
• "a control compulsion" 
• "an escape from the spouse?"

Are you driven by some need - power, control, status, money, success, compulsive perfectionism, or a guilty conscience?

If your motivation isn't clear, talk with your family or even your colleagues or see a therapist. Try to find the right job, relax, exercise & don't neglect your family (Fassel, 1993; Morris & Charney, 1983; Oates, 1979).

Often greater efficiency is more important than long hours. Although it's just getting started, Workaholics Anonymous may provide some information & WA group locations.

When to seek professional help

A wise self-helper will, of course, realize his/her limitations. Professional help is needed if the problems are too severe for self-help, this includes behaviors beyond one's control:

• serious alcoholism
• drug abuse
• suicidal depression
• intense hostility (where there is any risk at all that someone will be hurt)
• confusion
• criminal tendencies
• any problem serious enough to interfere with school or work.

Professional help is also appropriate if you have made a couple of genuine attempts to help yourself without success. Don't be ashamed of your self-help efforts & don't hesitate to seek expert help. It's just smart.

Nicotine: From 2004 to 2005: Teens who believe smoking cigarettes by someone their age is "not morally wrong" are more than 7 times likelier to smoke than those who believe teen smoking is "seriously morally wrong."

Nicotine, which is a stimulant drug, is one of the leading causes of death in the US.

The Food & Drug Administration (FDA) declared nicotine a drug on July 12, 1996, despite increasing protests by tobacco companies. Of all deaths in the US, 20% can be attributed to the effects of smoking.

Types  

• Cigarettes  

• Cigars  

• Pipes  

• Chewing tobacco

Methods of Use

Tobacco can be smoked in a rolled cigarette or cigar or in a pipe. It can also be chewed.

Nicotine Intoxication

Nicotine intoxication generally happens quickly because smoking is a highly effective delivery process. Nicotine goes straight to the lungs, where it's absorbed by the blood, sent to the heart & pumped into the arteries & brain.

Its effects on the body may include:

• Muscle twitching  

• Weakness  

• Rapid breathing  

• Rapid heartbeat  

• Abdominal cramps  

• Elevated blood pressure  

• Confusion, agitation

Depression

Life Risks
About 45% of all smokers will die of a tobacco-related health problem (Petro, Lopez, Boreham, Thun & Heath, 1992). Nicotine use has decreased among adult Americans, but it has been increasing among teenagers & children.

Nicotine is an addictive drug that can cause tolerance, dependence & symptoms of withdrawal. The tars in tobacco, not the nicotine, cause the cancers that frequently develop in the lungs, throat & other organs of chronic smokers.

Withdrawal

Physical withdrawal symptoms include:

• irregular heartbeat

• digestive problems

• irregular body temperature 

• intense cravings

Psychological symptoms include:

• irritability

• anxiety 

• sleep disturbance

Cravings for nicotine can last for days, weeks or years after a person stops smoking.

References
Peto R, Lopez AD, Boreham J, Thun M, Heath C Jr: Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet 1992; 339:1268-1278.

Cigarettes & Other Nicotine Products

Nicotine is one of the most heavily used addictive drugs in the US. In 2002, 30% of the US population 12 & older or 71.5 million people used tobacco at least once in the month prior to being interviewed.

This figure includes:

• 3.8 million young people age 12 to 17

• 14 million people age 18 to 25

• 53.7 million age 26 & older *

Most of them smoked cigarettes.

Cigarette smoking has been the most popular method of taking nicotine since the beginning of the 20th century. In 1989, the US Surgeon General issued a report that concluded that cigarettes & other forms of tobacco, such as cigars, pipe tobacco & chewing tobacco, are addictive & that nicotine is the drug in tobacco that causes addiction.

The report also determined that smoking was a major cause of stroke & the 3rd leading cause of death in the US. Statistics from the CDC indicate that tobacco use remains the leading preventable cause of death in the US, causing more than 440,000 deaths each year & resulting in an annual cost of more than $75 billion in direct medical costs. (See www.cdc.gov/tobacco/issue.htm).

Health Hazards

Nicotine is highly addictive. Nicotine provides an almost immediate “kick” because it causes a discharge of epinephrine from the adrenal cortex. This stimulates the central nervous system & other endocrine glands, which causes a sudden release of glucose.

Stimulation is then followed by depression & fatigue, leading the abuser to seek more nicotine.

Nicotine is absorbed readily from tobacco smoke in the lungs & it doesn't matter whether the tobacco smoke is from cigarettes, cigars or pipes. Nicotine also is absorbed readily when tobacco is chewed. With regular use of tobacco, levels of nicotine accumulate in the body during the day & persist overnight. Thus, daily smokers or chewers are exposed to the effects of nicotine for 24 hours each day.

Addiction to nicotine results in withdrawal symptoms when a person tries to stop smoking. i.e., a study found that when chronic smokers were deprived of cigarettes for 24 hours, they had increased anger, hostility & aggression & loss of social cooperation.

Persons suffering from withdrawal also take longer to regain emotional equilibrium following stress. During periods of abstinence &/or craving, smokers have shown impairment across a wide range of psychomotor & cognitive functions, such as language comprehension.

Adolescent smokeless tobacco users are more likely than nonusers to become cigarette smokers. Behavioral research is beginning to explain how social influences, such as observing adults or other peers smoking, affect whether adolescents begin to smoke cigarettes.

Research has shown that teens are generally resistant to anti-smoking messages.

In addition to nicotine, cigarette smoke is primarily composed of a dozen gases (mainly carbon monoxide) & tar. The tar in a cigarette, which varies from about 15 mg for a regular cigarette to 7 mg in a low-tar cigarette, exposes the user to an increased risk of lung cancer, emphysema & bronchial disorders.

The carbon monoxide in the smoke increases the chance of cardiovascular diseases. The EPA has concluded that secondhand smoke causes lung cancer in adults & greatly increases the risk of respiratory illnesses in children & sudden infant death.

Promising Research

Research has shown that nicotine, like cocaine, heroin & marijuana  increases the level of the neurotransmitter dopamine, which affects the brain pathways that control reward & pleasure.

Scientists now have pinpointed a particular molecule (the beta 2 (b2) subunit of the nicotine cholinergic receptor) as a critical component in nicotine addiction. Mice that lack this subunit fail to self-administer nicotine, implying that w/out the b2 subunit, the mice don't experience the positive reinforcing properties of nicotine. This new finding identifies a potential site for targeting the development of nicotine addiction medications.

Other new research found that individuals have greater resistance to nicotine addiction if they have a genetic variant that decreases the function of the enzyme CYP2A6. The decrease in CYP2A6 slows the breakdown of nicotine & protects individuals against nicotine addiction.

Understanding the role of this enzyme in nicotine addiction gives a new target for developing more effective medications to help people stop smoking. Medications might be developed that can inhibit the function of CYP2A6, thus providing a new approach to preventing & treating nicotine addiction.

Another study found dramatic changes in the brain’s pleasure circuits during withdrawal from chronic nicotine use. These changes are comparable in magnitude & duration to similar changes observed during the withdrawal from other abused drugs such as cocaine, opiates, amphetamines & alcohol.

Scientists found significant decreases in the sensitivity of the brains of laboratory rats to pleasurable stimulation after nicotine administration was abruptly stopped. These changes lasted several days & may correspond to the anxiety & depression experienced by humans for several days after quitting smoking “cold turkey.”

The results of this research may help in the development of better treatments for the withdrawal symptoms that may interfere w/ individuals’ attempts to quit smoking.

Treatment

Studies have shown that pharmacological treatment combined with behavioral treatment, including psychological support & skills training to overcome high-risk situations, results in some of the highest long-term abstinence rates.

Generally, rates of relapse for smoking cessation are highest in the first few weeks & months & diminish considerably after about 3 months.

Behavioral economic studies find that alternative rewards & reinforcers can reduce cigarette use. One study found that the greatest reductions in cigarette use were achieved when smoking cost was increased in combination w/the presence of alternative recreational activities.

Nicotine chewing gum is one medication approved by the FDA for the treatment of nicotine dependence. Nicotine in this form acts as a nicotine replacement to help smokers quit smoking.

The success rates for smoking cessation treatment w/nicotine chewing gum vary considerably across studies, but evidence suggests that it's a safe means of facilitating smoking cessation if chewed according to instructions & restricted to patients who are under medical supervision.

Another approach to smoking cessation is the nicotine transdermal patch, a skin patch that delivers a relatively constant amount of nicotine to the person wearing it. A research team at NIDA’s Intramural Research Program studied the safety, mechanism of action & abuse liability of the patch that was consequently approved by FDA.

Extent of Use

2003 Monitoring the Future Survey (MTF)**

Despite the demonstrated health risk associated w/smoking, young Americans continue to smoke. However, past-month smoking rates among high school students are declining from peaks reached in 1996 for 8th graders (21.0%) & 10th graders (30.4%) & in 1997 for seniors (36.5%).

In 2003, rates reached the lowest levels ever reported by MTF:

• 10.2% of 8th graders
• 16.7% of 10th graders
• 24.4% of high school seniors

reported smoking during the month preceding their responses to the survey.

The decrease in smoking rates among young Americans corresponds to several years in which increased proportions of teens said they believe there's a “great” health risk associated w/ cigarette smoking & expressed disapproval of “pack a day” smokers.

Students’ personal disapproval of smoking had risen for some years, but showed no further increase in 2003 among 8th graders & only small increases among 10th & 12th graders. In 2003, 84.6% of 8th graders, 81.4% of 10th graders & 74.8% of 12th graders stated that they “disapprove” or “strongly disapprove” of people smoking one or more packs of cigarettes per day.

Other Information Sources

For additional information on nicotine abuse & addiction, please visit www.smoking.drugabuse.gov.

Smoking is one of the hardest habits to stop without relapsing. Nevertheless, as a society, we're reducing smoking, about 1/2 of all people who've ever smoked have stopped (91% quit on their own).

After World War II, a high percentage of males smoked (75% in Britain). Perhaps 40% or 50% of all adult Americans have been "dependent" on cigarettes sometime in their lives.

During the 1990's, about 25% of Americans smoke, 75% of them want to stop. 2/3 believe a smoking-related disease will kill them if they don't quit. 1/3 of all smokers tried to quit last year, but only 1 in 20 who tried to stop was successful. Quitting requires an average of 7 tries, often using "cold turkey" or different methods.

Smoking in recent years is a habit for about 40% of high school drop outs but only 10%-15% of college graduates smoke. Likewise, smoking is more & more associated with:

• personal & social problems
• bad experiences as children
• doing poorly in school
• unskilled work
• divorce
• stressful conditions (more panic attacks)
• unemployment
• criminal behavior among males
• serious mental illness
• depression
• drug & alcohol use, etc.

Like alcohol, cigarettes with their nicotine content may, for some people, serve as a self-medication for a variety of psychological problems, especially stress & sadness.

Note: a few adolescents enjoy the first puff - scientists believe this is determined by their genes.

In the main, however, smoking starts for basic social reasons, even though it tastes bad to most, but it becomes an addiction because nicotine is physiologically addictive & because smoking may help us momentarily (while having "a smoke") avoid stressful & depressing thoughts (& thus, feelings). The truth is, in spite of the belief that "I need cigarettes to relax," smokers are generally more anxious than non-smokers & more anxious than they'll be if they quit.

Note: Smoking is another addiction that's being "demonized." The statistics just cited, e.g., would seem to be demeaning to smokers by implying they're less educated & "lower class."

This isn't my intention. We must guard against the mental put-down of persons suffering a powerful habit & a physiological addiction. Unfortunately, society more & more is seeing smoking, like over-weight, as being due to laziness, a weak will, weak character, stupidity, or slovenliness.

This doesn't help people change; it makes them more self-critical & unhappy. Very few of us have mastered all bad habits, so we should be especially sympathetic with smokers who have, as we'll see, innocently acquired an extremely persistent behavior. Let's not blame the victim!

Reporting in the July issue of the journal Archives of General Psychiatry, the team compared standard personality assessments for 939 young adults diagnosed w/problem gambling, alcohol, marijuana & nicotine dependence.

The researchers found that these conditions were often linked. "Past-year problem gambling was significantly associated w/ past-year alcohol dependence, cannabis dependence & nicotine dependence," the study authors wrote.

"The associations between problem gambling & the 3 substance use disorders were similar in magnitude & were nearly as large as the well-established association between alcohol & nicotine dependence."

Personality traits were also "strikingly similar" to those often seen in drug or alcohol addicted adults, the researchers reported. They found that young adults diagnosed w/problem gambling before age 21 were more likely to score high in impulsivity & risk-taking behaviors, as well as negative emotions, on personality tests taken at age 18.

More information

The U.S. National Library of Medicine has more about compulsive gambling (www.nlm.nih.gov ).

Gambling Addiction

Gambling is one of the fastest growing industries in the US. Some forms of gambling are:

• lotteries
• casinos
• pari-mutuels (i.e., dog & horse racing & Jai-Alai)
• bingo
• bookmaking
• card rooms 
• the stock market

People with a gambling addiction make gambling the center of their lives, at the cost of relationships, career or health.

The idea of a big payoff triggers chemical reactions in the brain that activate the brain's pleasure center. The pleasure center gives the euphoric experience that addicts seek thru drug use.

As gambling behavior progresses, the individual obsesses about a big win, thus activating the pleasure center. Gambling & thinking about gambling are associated with the pleasant experience mediated by the pleasure center & a craving for gambling results. The craving may overpower good judgment & it intensifies the gambling addiction.

Gambling addiction becomes a problem when it interferes with important areas of life. Compulsive gamblers may be in total denial that they have a problem, even if the addiction is ruining their lives. Gambling addiction follows a progression, like any other addiction & it's often maintained by defenses that keep the addict from confronting the problem.

Warning Signs

Loss of time from work or home due to gambling

Feelings of remorse or guilt after gambling

Borrowing money to finance more gambling

Feeling anxious after gambling due to losing money

Arguments w/loved ones or friends due to gambling

Repetitive thoughts about "winning big"

it's in the news about gambling....

Gambling Addiction Resembles Brain Problem:  Poorer Choices, More Errors Seen in Chronic Gamblers' Mental Tests

Start Gambling Early, Get a Losing Hand

Reuters Health - By Alison McCook - Tuesday, November 2, 2004

NEW YORK (Reuters Health) - Teenagers who gamble are more likely than other people their age to say they also drink alcohol & take drugs, new research reports.

Young gamblers also reported higher rates of addiction to alcohol or drugs & appeared to be at higher risk of depression. Moreover, adults who started gambling before age 18 were also more likely to report using drugs & drinking alcohol & be addicted to both, than adults who didn't gamble.

These findings suggest that unhealthy habits may be contagious, Dr. Wendy J. Lynch told Reuters Health & starting to gamble early in life puts people at particular risk of having problems immediately or later in life.

Just why getting an early start on gambling appears to up the risk of other problems is unclear, she said. People who gamble at young ages may simply have a "vulnerable personality" to other unhealthy behaviors, or the "thrill-seeking" nature of gambling may sensitize them to other, thrill-seeking activities like drugs & alcohol.

"I don't know that one thing causes the other," the researcher, based at Yale University in New Haven, Connecticut, said.

Regardless, gambling among teenagers may serve as a warning sign that they're at risk, Lynch said & dealing with the gambling may help protect them from other troubles.

Despite the fact that gambling is largely illegal for teenagers, up to 90% of people between the ages of 12 & 17 say they've gambled within the last year, according to the Archives of General Psychiatry report.

Previous research has suggested that young gamblers may be more vulnerable than other gamblers to problems that go along with gambling. To investigate whether this is the case, Lynch & her colleagues surveyed 1,076 teens & adults about their gambling habits & psychological health.

The researchers considered people alcohol users if they drank alcohol at least once or twice per month in the last year & drug users if they took drugs at least 5 times in the last year. People were classified as depressed if they said they'd ever spent 2 weeks feeling sad, empty or lost interest in the things they used to enjoy.

All types of gamblers, regardless of their age & when they started gambling, were more likely than non-gamblers to drink alcohol.

However, teenage gamblers & adults who started gambling early were more likely than non-gamblers to say they were addicted to either drugs or alcohol in the last year.

Moreover, teen gamblers & adults who began gambling before the age of 18 appeared to have more of a problem with drugs & alcohol than adults who started gambling later in life.

Young gamblers tended to gamble for different reasons than older gamblers. Specifically, they were more likely to say they gambled for social reasons & less likely to do it to win money & lose or win large amounts while playing.

SOURCE: Archives of General Psychiatry, November 2004.

Gambling: Many people occasionally gamble small amounts at a local state-approved casino or on trips to Atlanta or Las Vegas. They're social gamblers, like social drinkers & some spend quite a bit of time in a casino but they're not out of control.

Most people gamble for excitement, novelty & fun; some do it to escape stress. Unfortunately, the people who need money the most, gamble the most. People who make less than10 to 15,000 dollars a year gamble 5 times more often than those who earn over 50,000 dollars a year. About 1/3 of problem gamblers are women.

We aren't talking about gambling for fun here; we're discussing a powerful habit or mindset that occupies most of your free time, wipes out your savings, leads to stealing, writing bad checks & neglecting your children & destroys relationships.

Gamblers drop over 50 billion dollars every year, 30% comes from problem gamblers.

That's more money than spent on movies, recorded music, theme parks & sports events combined! That's huge. Ironically, gambling brings in 12 billion to 37 state governments, but those states spend only 20 million to help the addicts, with ruined lives, get treatment, education or prevention.

Robert Custer, MD, writing for the Illinois Institute for Addiction, describes 3 common phases in gambling addiction. First, there's a winning experience or phase, a happy time that hooks them into hoping for more windfalls.

They quickly become unduly optimistic (“I have a feeling I’m going to win”) & start betting larger amounts. Second, is the inevitable losing phase. Still bragging about previous winnings, they now start to gamble alone & obsess more about winning back their losses.

The problem, as they now see it, is how to get more money so they can recoup their losses. They start lying about their activities & losses; they raid or beg for spouse’s & relative’s money; they may become withdrawn, anxious & irritable when they can’t pay their debts.

Last is the desperation phase. Many feel hopeless panic knowing they're in an impossible economic situation. They may blame others or get very depressed, about 1/2 abuse alcohol or drugs. Divorce, arrests (2/3’s commit crimes), mental breakdowns, etc. aren't uncommon.

The Illinois Addiction Recovery web site (see above) has a test to help you determine if you have a gambling problem. Over 85% of Americans have gambled at least once, so remember it's causing problems & getting into trouble that defines a serious addiction.

Gamblers with significant problems make up only about 1%-2% of the American population. It's important to note, however, that teenagers are 3 times more likely than adults to become problem gamblers.

Each “problem gambler” costs the taxpayers about $3000 a year, according to the University of Chicago’s National Opinion Research Council. Moreover, as the state-run lotteries become more popular w/huge payoffs, addiction rates go up.

Every gambler in some part of his/her mind recognizes that in the course of time he/she will almost certainly lose money. Yet, gambling enthusiasts somehow contort their minds into believing that they not only can win but have a “good chance” of winning. It's very irrational thinking.

There's evidence that Cognitive-Behavioral treatment focusing on correcting misconceptions about gambling (as well as teaching problem-solving, social skills & relapse prevention) can be successful (Sylvain, Ladouceur & Boisvert, 1997).

However, most of the gambling treatment centers associated with  hospitals & psychiatrists are, like alcohol programs, associated with  12-step programs (see Gamblers Anonymous or call 1-213-386-8789).

The Gambling Help Line (1-800-522-4700 or 1-800-GAMBLER) offers crisis counseling & info, including treatment & GA group locations. Gam-Anon can be reached at 718-352-1671.

The search engines, such as Yahoo & Alta Vista, list some of the gambling treatment programs available around the country. Few treatment centers will serve gamblers who have lost their savings & health insurance & can't pay for the services.

Gamblers in serious trouble only have Gamblers Anonymous.

More info is available from the National Council on Problem Gambling. Also, some states have comprehensive Web sites concerned w/several types of addiction, such as the Illinois site cited above & the Michigan Compulsive Gaming Help Line.

Other Web information sources include Gambling Treatment which is just one of about 10,000 treatment centers (see the search engines).

Hazelden offers several books about this addiction, mostly testimonials, inspirational, or informational, not many explicit self-help approaches. Indeed, the general view seems to be that gambling addicts with serious problems must seek treatment, not try to do self-help themselves.

Walker’s (1996) book while descriptive doesn't offer a lot about treatment & even less about self-help methods. Of course, self-control is probably possible for most people who are just starting into the losing phase. This entails just staying away from gambling, i.e. cutting your losses & avoiding, at all costs, the temptation to “chase” your losses (trying to recoup your losses by betting more). If that doesn’t work, get help.

Several years ago, doctors at the Mayo Clinic noticed something odd about some of their patients with Parkinson's disease. Soon after starting a type of medication to reduce symptoms, people who had rarely or never gambled couldn't stop. For example, a 68-year-old man who had never gambled began compulsively gambling—losing $200,000 in six months—after he started taking a drug called Mirapex. But he stopped gambling when he quit taking the medication.

The doctors' observations, published online this week in the Archives of Neurology, suggest that drugs in a class called dopamine agonists, which includes Mirapex, might be to blame for the behavior. The report, which describes an onset of pathological gambling in 11 patients after they took dopamine agonists, does not conclusively prove that the medications are associated with an increased propensity to gamble, but the authors write that the association was "striking." Previous studies have also linked dopamine agonists to compulsive gambling, though only in a small minority of cases.

Dopamine agonists work by mimicking the effects of the neurotransmitter dopamine, which helps people coordinate movement and influences how people experience reward and pleasure. Because Parkinson's results from a lack of dopamine in certain areas of the brain, these drugs can ease symptoms of Parkinson's, like tremors. However, at the same time, the drug affects people's impulsiveness and their need for the rush that dopamine can give in anticipation of a reward—such as winning at the slots.

John Nikolakis came from a privileged family. Few would have predicted that last September, at the age of 36, he would be alone in a dark, cold Louisiana apartment - all the utilities were cut off because he couldn't pay for them - dead broke and writing suicide notes.

He was on probation for having embezzled nearly $80,000 from his former employer. His entire adult life had been consumed by the intoxication and compulsion of gambling away hundreds of thousands of dollars on everything from online poker to sports.

He lost two good jobs, one girlfriend, and 17 years of his life. "This gambling crap has cost me everything," he says. "It cost me my pride, my honesty, and the biggest thing it cost was the relationships of people who cared for me."

His story, with as many variations as there are individuals, illustrates the trajectory of most pathological gamblers: a period of exhilaration and great windfalls - punctuated by a little dishonesty here and there - ending in misery, financial ruin, and shattered personal relationships.

In 1980, the American Psychiatric Association officially categorized pathological gambling as a diagnosable medical disorder, and since then there has been increasing understanding of the brain chemistry, the biology, even the genetics that play a role.

As pathological gambling has become more fully understood as a discrete disorder, more-sophisticated treatments have evolved. But pathological gambling has its own distinct pathology, so there are new and promising drug and therapeutic interventions as well.

Experts often describe pathological gambling as being both a "pure" and a "hidden" addiction. It is pure because it does not change the brain chemistry by introducing other substances like drugs or alcohol do. It is hidden because unlike, say, mainlining heroin, gambling is generally a socially acceptable behavior.

Socially acceptable behavior run amok, that is. The pathological gambler needs to wager more and more money to achieve that deeply satisfying, and addictive, point of excitement. These and other signs indicate the difference between the person who takes an occasional trip to Atlantic City and someone with a real problem. And withdrawal can be punishing, with terrible headaches, irritability, and anxiety.

Bad willpower. Experts say that pathological gambling is a problem that affects 11 million people - with 1.6% of adults being pathological gamblers and an additional 3.9% suffering from problem gambling - and merits far greater attention than it has received.

"People think it is poor character, bad willpower, someone is flawed in terms of moral strength," says Jon Grant, assistant professor of psychiatry at Brown Medical School and coauthor of Stop Me Because I Can't Stop Myself. "Many people don't have a clue that this is a biological illness with a distinct pathophysiology."

Scientists are learning that the brain and even the genes of a pathological gambler differ from those of the occasional poker player. In research presented last month at the American Academy of Neurology's annual meeting, scientists pointed to the prefrontal cortex, that part of the brain responsible for decision making and impulse control, as being impaired in pathological gamblers.

Eating Disorders

Eating Disorders are severe emotional disorders of self-esteem that are focused on food. For persons with an eating disorder, food becomes an obsession. Although compulsive overeating is a form of eating disorder, the most common forms are anorexia & bulimia. Eating Disorders can be fatal when malnutrition becomes severe.

Risk Factors for Anorexia
Persons with anorexia often have a terrible fear of being overweight. They fear that they're too fat & place themselves on extreme diets that lead to severe & dangerous weight loss. Convincing anorexics that they're actually dangerously thin or malnourished is difficult or impossible.

Risk Factors for Anorexia
Anorexics in particular seem to be particularly sensitive to being perceived as too fat. They may also fear losing control of their eating habits & may have a strong desire to control or contain powerful emotions. Anorexics may compulsively exercise, count calories, starve or severely restrict food, self-induce vomiting & irresponsibly use diet pills, laxatives or diuretics.

Some personality characteristics, behaviors & physical attributes are also warning signs of anorexia.

Personality Characteristics

Low self-esteem

Overachiever

Compliant

Perfectionist

Compulsive

Behaviors

Eats alone

Fights with family

Becomes isolated from friends & family

Physical Attributes

Fatigued

Increased body & facial hair

Weight loss

Cessation of menstrual cycle

Joint pain

Emaciated appearance (in later stages)

Low self-esteem

Self-indulgent

Depressed or anxious

Fatigued

Apathetic

Behaviors

Eats alone

Self-induces vomiting

Experiments w/laxatives or diuretics

Becomes isolated from friends & family

Lies

Steals food or money

Abuses drugs

Has suicidal behavior

Physical Attributes

Normal body weight

Stomach problems

Tooth damage

Abnormal potassium & electrolyte levels

Chronic sore throat

Heartbeat arrhythmia

Bulimia & anorexia may overlap in some persons, so it's possible to have both eating disorders at the same time.

Eating disorders or just overeating: see examples of 20 Methods for Controlling Behavior (mostly for overeating).

It's estimated that 55% to 70% of us Americans are overweight, about 25%-35% of us are just plain obese (20% or more over-weight), while another 12% are classified severely overweight.

An estimated 44% of us go on a diet sometime during each year, explaining the enormous amount spent on diet books. Fat, especially in our upper body, endangers our health.

In women, the risk of heart disease increases w/the addition of only 10 - 12 lbs. above your ideal weight or your weight at 18. The obese have 3 to 5 times the risk of heart disease, 4 to 5 times the risk of diabetes, more back trouble & in general, a lower quality of life for a shorter while.

Ordinary, simple overeating is very common but there are several types of quite serious eating disorders. Overeating can develop into frequent recurrent overeating episodes called Binge Eating Disorder.

There's a chance that bingeing &/or very strict dieting can develop into Bulimia or Anorexia. Bulimia involves impulsive binge eating followed by harmful self-induced vomiting, laxative or diuretics use & compulsive exercise.

Anorexia involves seeing one's self as fat when in reality you're very thin; this is a dangerous disorder because anorexics may refuse to eat, eventually starving themselves to death (1 in 10 die from a related cause).

About 10 million American women have an eating disorder, although it's adolescent & young women who account for 90% of the disorders - 50,000 will die as a result.

About 15% of teenage girls have some kind of eating disorder but only 1/3 seek help (some are embarrassed, others don't realize they have a serious problem). Bulimics often remain normal in weight, so no one else knows, but between 1% & 3% of young women suffer this disorder. Men are as over-weight as women but they don't have anorexia & bulimia nearly as often.

Although often left untreated, eating disorders can devastate the body & the mind (depression, anxiety, addictions). I won't give details, but believe me, this is a serious matter. Eating disorders &/or being obese (say, 50+ pounds overweight) should usually be treated by professionals - these are deeply ingrained addictions & often not responsive to self-help.

Ideally a team is needed: psychologist, physician & nutritionist. Ordinary overeating or moderate overweight may be a self-help problem. But when your weight creates a physical problem or a serious psychological problem or if your self-help efforts just aren't working any more, get professional help.

Some sources of information & professional treatment for eating disorders are given below, but the self-help methods & references mentioned here are for toning up & shedding up to 20-30 lbs. over many weeks or months.

Losing weight requires either taking in less or burning off more. The research strongly suggests that both a restricted diet (fewer calories, less fat, more fruit & vegetables, less snacking, avoiding rich foods) & an exercise program (burning 1000+ calories per week) are necessary for most overweight people.

Indeed, some studies have indicated that for some people weight loss may only come w/ vigorous (90% of maximum) exercise for months, not light exercise.

Hard exercise seldom makes you feel tired, to the contrary, exercise usually gives you energy (although you may go to sleep earlier). There are people, however, who find hard exercise so unpleasant that they'd stop trying to lose weight if they had to exercise. So, adjust to your needs.

Feeling tired is often actually caused by the lack of exercise, called "sedentary inertia." So, a demanding exercise program is for some a must, for others moderate exercise & a restricted diet will work. Several Web sites discuss exercise: APA Help Center & CNET: Downloads contain 50 or more software programs to aid weight loss via exercise. Many search engines will generate a few thousand weight loss & exercise sites.

It has been demonstrated that many women are in a bad mood (more depression, insecurity & anger) after viewing pictures of fashion models. Some therapists think the combination of envying thin models & a negative self-critical mood prompts women to binge & then purge.

Note: eating disorders increased 5 fold in teenaged girls soon after TV came to Fiji. There can be no doubt that Americans are unhappy w/how they look, about 65% of women are dissatisfied w/ their weight. How dissatisfied?

Psychology Today (Jan, 1997) did a survey that showed that 24% of women & 17% of men would sacrifice 3 years of their life to be their desired weight. It becomes an unhealthy cycle: body loathing causes emotional distress which increases the disgust w/the body.

Psychology Today's suggestions for accepting & feeling better about your body are: Stop looking at fashion magazines or ads anywhere. Realize your self-concept must be much broader than looks; weight isn't what makes you a good or bad person.

Appreciate all the uses, abilities & uniqueness of your body just as it is. Do things that make you feel good about your body - exercise, dress well, have good sex, etc. Change or get out of negative relationships.

Develop positive self-talk about your looks to replace the criticism. Learn people skills, especially empathy, "I" statements & assertiveness (ch. 13), so you're more caring & likeable (counterbalancing the prejudices people have against over-weight people).

Clearly one of the questions facing every overweight person is this: Is the problem my habitual overeating or some underlying emotions that drive me to eat? The answer isn't easy. Being over-weight may upset us & emotions may cause over-eating.

i.e., over-weight 9 & 10-year-olds don't suffer low-esteem but by 13 or 14 they do! On the other hand, people dieting, who have a history of depression, are at risk of becoming depressed again (the same is true of people stopping smoking).

So, the answer is "well, for some people it's just family customs or habits of loving beer & pizza" & for other people the answer is worry about body image, depression, marital stress, conflicts at work, workaholism, or hundreds of other possibilities. You may need to figure it out in your case.

Capaldi (1996) tries to help us understand how eating patterns are based on life experiences & how to change those patterns. Thompson (1996) explains more about the connections between body image & eating.

A good book to help you start exploring the emotional possibilities underlying eating is Abramson (1998). To consider the more psychoanalytic reasons for overeating, such as an unconscious desire to be fat or a fear of being thin & sexy, read Levine (1997).

There's probably no way to determine w/any certainty the role of motions in driving your food/drink intake except by

(a) keeping a diary of the events in your life, your emotional reactions & your food intake

(b) openmindedly reading therapy cases & asking yourself "Could this be true of me?" 

(c) getting therapy

Keep in mind that although a lot of research is being done & much is thought to be known, we're still pretty ignornant about all 3 - weight, emotions & changing our bodies. Many studies are small, say w/20 subjects or so & result in conflicting "findings," other studies are suspect because they were supported by companies selling a product or people pushing a diet & some pronouncements just aren't true.

i.e., a recent study (Anderson, 1999) reported that very over-weight dieters who went on a very low calorie diet (500-800 calories per day) & lost weight quickly had kept more pounds off 7 years later compared to slow losers.

That's in conflict w/the standard expert recommendations, like Weight Watchers, of a slow loss of weight by learning new eating habits. Likewise, it's popular to pronounce that losing weight (e.g. 5% or 10% of your weight) doesn't prolong life but exercising does.

Yet, there are new findings (Scientific American Frontiers, Public Television, Jan 25, 1999) suggesting that a very low calorie but nutritious diet improves health & prolongs life by a very significant amount, at least in mice. Let's not get too certain of what we "know." One thing everyone agrees on however: consult w/a doctor if you're considering an extreme diet (which may cause gallstones & perhaps other problems).

Important health concerns & our excessive obsession w/thinness result in the brisk sale of diet, cook & weight loss books. The hundreds of new diet books every year mainly repeat each other.

And nutritional theory changes like fashions from a high carbohydrate diet to high protein diet to low fat, back to a Mediterranean diet (w/olive oil) & we will go to something new next year.

Pritikin (1998) says there are 3 ways to lose weight:

(1) a restricted diet (but many are always hungry)

(2) high protein, low carbohydrate diet (not healthy & still hungry)

(3) low fat, high fiber diet (his diet=veggies, fruit, grain, low-fat animal foods)

In any case, the food intake has to be well controlled to lose weight, so it's important to be nutritionally well informed. See Wills (1999), The Food Bible & Food and Drug Administration, NIDDK Health Information, or Dietary Guidelines.

Another critical skill is behavioral self-control as spelled out in the Methods for Controlling Behavior section of this chapter. Several books, some fairly old, also spell out techniques for controlling eating over the long haul.

Keeping in mind that calming the emotions that trigger eating-for-comfort & using diet/exercise methods that you can enjoy for a long lifetime are important, try some of these books:

Kirschenbaum, 1994; Virtue, 1989; Mahoney & Mahoney, 1976; Fanning, 1990; Jeffery & Katz, 1977; Stuart,1978; & a diet program by Marston & Marston, 1982.

Now mushrooming weight loss Web sites have joined books. Here are some of the better ones: American Dietetic Assoc., Cyberdiet.com, S-H & PSY, Cyberguide to Stop Overeating, Healthtouch--Weight-Control & Dieting, National Eating Disorders, Overeaters Recovery, Growth Central ,which offers individual & group programs & Obesity & Weight Control which is mostly about drugs for losing weight. Like the weight loss books, the Web sites are very redundant. Two or three should be enough.

Local diet & exercise centers are also available almost everywhere. Remember before investing money that most diet programs produce weight loss but 95% fail eventually, usually within 1 to 5 years.

However, the better your general coping skills, as described in the Methods section of this book or in the books cited above, the more likely you will take it off. And if you focus on relapse prevention & maintenance, you can keep the weight off.

It's probably fair to say that the people who maintain their weight loss also exercise for life, have social support, understand behavioral self-control methods & confront their personal-emotional-interpersonal problems directly.

The strength & tenacity of bad eating habits is shown by Perri's (1998) review of the effectiveness of weight loss programs w/obese patients. Most programs take off some weight & some programs continue the maintenance of weight loss by extending the treatment & using phone calls as follow up.

But, as Perri says, maintenance effectiveness tends to dissolve after termination. That means that you have to pay as much attention to relapse prevention as to weight loss. See Relapse Prevention in chapter 11 to control your impulse eating & re-start the weight loss plan as soon as you regain two pounds!

Opinions differ about dieting. The professionals who work with anorexics & bulimics caution against diets because severe dieting is seen so often in their clients' history (they favor exercise rather than diets).

To prove their point a recent study found that the 8%-10% of teenage girls who dieted severely were 18 times more likely to develop an eating disorder than girls who had not dieted. (It shouldn't surprise anyone that diets are the first step but the study underscores that severe dieting may serve as a warning sign.)

Another group of professionals simply say all diets are bad because they don't work in the long run. On the other hand, professionals dealing w/very overweight clients consider diets to be a main solution to serious health problems.

The facts are: obesity is certainly a health risk; weight loss is usually beneficial but can increase certain risks, e.g. yo-yo dieting year after year is associated w/certain chronic diseases; diets do work (maintenance often fails); learning how to maintain weight loss is badly needed (Brownell & Rodin, 1994).

Many diet centers & hospitals offer classes for extremely overweight people which provide detailed knowledge about how the body uses food, the role of fiber & fat, how to prepare better meals & how much exercise is needed.

Many (indeed, most) people don't know these things about nutrition, but once they know exactly how their diet & exercise program needs to be changed, they'll often do it. I urge you to get that knowledge. Two of the better current books about fat & nutrition are by Bailey (1991, 1999) & Ornish (1993).

Bailey also has 4 PBS videos (1-800-645-4PBS). It's commonly thought that very strict diets will be so unpleasant that people will not stick w/them, but research has shown that stricter diets are actually more effective. Strict diets tend to be simpler & easier to follow.

Losing weight may require attention to your feelings & interpersonal relationships. Obviously, if overeating is a misguided attempt to handle some emotional pain, the emotions need to be dealt with. See Abramson (1993) for ordinary "emotional eating" & Sandbeck (1993) for the shame, guilt & low self-esteem that often underlie bulimia or anorexia.

Virtue (1989) & LeBlanc (1992) also address this specific situation. Farrell's Lost for Words, a psychoanalytic view, is online. Empty lives can cause cravings for food; unhappy spouses gain 2 to 3 times the weight that happy spouses do!

For the various unhealthy psychological uses of fat in a marriage, see Stuart & Jacobson (1987). Therapists report that over-eaters often need unusual attention, nurturance & warmth. Roth (1989, 1993), a good writer & Greeson (1994) have written that food is used to replace the love that is missing.

It's been reported that depression may increase while dieting but people are usually happier after the fat is gone (Brownell & Rodin, 1994). Interestingly, interpersonal therapy focusing on relationships & attitudes toward weight has been just as effective as cognitive-behavioral therapy focusing on eating habits. Self-help groups are often helpful, too (Weiner, 1999).

To find a support group online: Mental Earth Community, Grohol's Forums, Support Groups, Support Path.com, Eating Disorder Recovery Online, and a newsgroup at alt.support.eating-disordFAQ. Support groups are also discussed in the next chapter.

Another resource you should consider seriously is Overeaters Anonymous, a world-wide organization. To find a local group see Overeaters Anonymous in your White or Yellow Pages or email overeatr@technet.nm.org for information. There are two OA Web sites: Recovery & Overeaters Anonymous.

Keep in mind that 12-step programs, like OA & AA, need to be supplemented w/nutritional information & cognitive-behavioral self-help methods. A caution: it has been reported that some anorexics become more anorexic after interacting w/fellow anorexics in support groups or chat groups.

Since most people try to lose weight on their own, it is to be expected that self-help programs and methods will appear. Fairburn (1995) has developed a science based self-help program for overcoming the binge eating. Crisp, Joughin, Halek & Bowyer (1997) offer self-help to anorexics.

Schmidt & Treasure (1994) describe self-help methods for bulimics. Remember, serious eating disorders need professional help too. Peterson, et al (1998) found that a structured group self-help approach was as effective with binge eaters as therapist lead psychoeducational and discussion groups. Burnett, Taylor & Agras (1985) and, more recently, Personal Improvement Computers have developed small hand-held computers that assist moderately overweight patients to control and monitor their food intake.

Web sites providing information for losing weight were given above but even more sites are offered for understanding the more serious eating disorders: Eating Disorders (see "Best on the Net"), MHN-Eating Disorders, ivillage diet, Eating Disorders, Futter Eating Disorders, Lucy Serpells Eating Disorder Resources, American Anorexic Bulimia Association, Concerned Counseling Eating Disorders, Surgeon General, Assoc of Anorexia Nervosa & Associated Disorders, Something Fishy's Eating Disorders, and, lastly, more treatment programs for serious eating conditions, Binge Eating.

Bulimics and anorexics usually have additional psychological and interpersonal problems beyond the abnormal eating. They often have poor social skills and are frequently in conflict with family members. Young bulimic women tend to be dependent and have trouble separating from their mothers. Judi Hollis (1994) says she has never met a starving or bingeing woman who wasn't raging inside, usually at her mother. Serious eating disorders require professional treatment.

People with eating disorders need to learn better communication and problem-solving skills and, then, change their eating-exercise habits, such as having regular meals that include previously avoided foods, learning new ways of handling the bingeing-purging situations, and modifying their attitudes towards their shape and weight (see the previous section in this chapter). This usually means therapy. Thus far, the cognitive-behavioral methods are only fairly effective with bulimia by persuading the patient to stop dieting since bingeing is a natural reaction to starving the body (Wilson, 1993). Also, after the binge-purge cycles stop, the person needs to cognitively accept his/her "natural weight," based on healthy food and exercise. Keep in mind, serious eating disorders are remarkably resistant to change; only half of patients in treatment will be fully recovered in five years (American Journal of Psychiatry, 1997, vol 153). Like all long-term disorders, bulimia and anorexia place great stress on the family; they all may need help (Sherman & Thompson, 1997). Unfortunately, the prevention programs for young at risk women have, thus far, not been effective. These urges are hard to change.

There are many additional sources of help. See Bennion, Bierman & Ferguson (1991) for a factual discussion of weight control. Parents worry about their children's weight too; there is help (Archer, 1989). Perri, Nezu, & Viengener (1992), Epstein, et al (1994), and Brownell & Wadden (1992) provide therapists with guidelines for managing serious obesity. For information and referrals about anorexia and/or bulimia, call 847-831-3438. For more information about locating Cognitive-Behavioral therapists, call 212-647-1890 or try the Web site for abbt. All obese people and persons with an eating disorder should have a psychological or psychiatric evaluation, including an assessment of the family. Most importantly, you must realize that extreme anorexia, called "the fear of being fat," can be fatal (5% die, half from complications and half from suicide); don't put off getting professional treatment for anorexia and bulimia, three-quarters can be helped by behavioral therapy. See eating disorders at the end of the next chapter.

Guidelines for Losing Weight if Moderately Overweight

1. Remember the expertise of 3 disciplines are involved: psychology, nutrition & medicine. You need to know some of all 3.

2. Become familiar with the 20 Methods for Controlling Behavior described above.

3. Realize that good weight loss is probably not starving, a crash diet, pills, or a special “program,” it's simply acquiring the habits to eat good tasting, healthy food in the right amount for the rest of your life.

For some dieters, especially those w/a lot to lose, a special diet is necessary to get satisfying results. Get your "bulk," as my Grandmother used to say. That means high fiber - vegetables, beans, fruit, nuts & grains - which give you only half as many calories as meat, sugars, cheeses & fried foods.

An occasional "day off" may make a long diet more tolerable.

4. Weight loss almost always involves increased exercise. Be active, move around even in sedentary jobs; it’s good for you. If exercise is hard for you & you do little, read Fenton & Bauer (1995) who recommend walking. Also, strength training ("pumping iron") will add muscle as fat comes off; muscle burns more calories & keeps your metabolic rate high (Nelson, 1999). If you're not used to hard exercise, see a physician, build up gradually & guard against injuries.

5. To drop one pound of weight each week: Cut 250-300 calories per day (1 candy bar, 2 light beers or soft drinks, 3-4 oz. of meat or cheese) & exercise more each day (1 hour walking or yard work, 1/2 hour jog or bike ride, 1/2 hour swim). One pound=3500 calories.

6. Find a time of relative quiet in your life to start your new eating/exercise habits. Once started, avoid missing any days (if it happens, get back on schedule as soon as possible).

7. Eat at times & in sufficient amount so you don’t get hungry. Relax & enjoy eating. Don’t let your calorie intake drop below 1100 calories per day.

8. Your genes may be a factor. Eating Disorders & being overweight tend to run in families (that doesn’t prove it is genetic).

However, depression, low self-esteem, helplessness, poor body image, anxiety, obsessive-compulsive habits & sometimes perfectionism, addictions & impulsiveness also run in families w/ Eating Disorders.

Histories including teasing, rejection, abuse, death of a loved one & giving birth are common. These factors make losing weight a little harder but they won’t stop a determined self-helper.

9. Realize that medication can be of help w/certain eating disorders, especially bulimia.

10. If changing your eating habits seems to be impossible after several weeks of trying, get serious about discovering the emotions & needs underlying your overeating (see the books & Web sites listed above). If that doesn’t work, get professional help from a psychologist w/experience in this area.

11. Find the emotional roots of your urge to eat. What are the psychological concerns (relationships, frustrations, needs) underlying the eating problem. If you can reduce those concerns, you have a better chance of stopping overeating & of avoiding relapse (The Weight Control Digest, May/June, 1997).

12. Keeping a food diary is very helpful, especially if you record the circumstances in which the urge occurs, what you were thinking, feeling & doing immediately before hand & how you responded to the urge to eat. A graph showing your progress can be very satisfying. A recent study at Duke University shows that bingeing by women is triggered by depression, getting off their diets, gaining weight, low self-esteem & anxiety. Bingeing by men is preceded by anger, getting off their diets, thoughts of food, conflicts & fasting. Plans ways of dealing w/your triggers to binge.

13. Celebrate & brag when your pants are loose & slipping down. (Actually it's important to reward in some brief way the achievement of each daily & weekly goal.)

14. Make plans to maintain your gains. Use relapse prevention if needed. In any case, get serious about your weight whenever you gain 2-3 pounds over your desired weight, taking into account your normal weight changes by time of day & for women, time of month.

Sex Addiction

People who become involved in excessive sexual activity or who have a constant preoccupation w/sex may have a sex addiction. Addicted individuals make getting sex or sexual stimulation the center of their lives, at the cost of relationships, career or health.

As w/any addiction, sex addiction becomes a problem when it interferes with important areas of life. Sex addicts may be in total denial that they have a problem, even if addiction is ruining their lives.

Risk Factors
Sex addicts usually lead lives filled w/shame & secrecy. The shame comes from inability to control a harmful behavior. The secrecy is necessary to hide the behavior in the interest of staying out of trouble.

Warning Signs

A person who has a sex addiction may:

Engage in sexual activities that involve taking risks the person wouldn't consider under other circumstances

Conceal sexual behavior from family & close friends

Increase the frequency of sexual activities to more intense levels in order to achieve previous levels of excitement & relief

Addicted to Love

"Love is all you need." For the person addicted to love, this becomes more than a popular lyric. It becomes literal truth. What is love addiction & why are some men & women addicted to love? How can the problem be identified & how can those addicted be helped?

A Psychological Addiction

Love addiction is a psychological addiction, a result of unfulfilled childhood needs. Children whose needs remain unrecognized may adjust by learning to limit their expectations. This limitation process may take the form of harmful ideas such as:

• "My needs don’t count."
• "Getting close will hurt." 
• "I’m not worth loving."

Such ideas don't satisfy childhood needs, leaving them still to be met later in life. As adults, addictive lovers remain dependent upon others to care for them, protect them & solve their problems.