- Coming up next on "IGI," we discuss behavioral or process addictions, what they are and how they impact our lives.

Please stay with us.

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(cheerful upbeat music) Welcome to "I've Got Issues."

I'm your host, Betty Lou Pardue.

When many of us hear the word addiction, we think of drugs or alcohol.

But millions of Americans suffer from addictions to various activities, or even behaviors, what is sometimes called process addiction.

Here to discuss are Ronna Corliss, Problem Gambling Program Manager for the Kansas Department for Aging and Disability Services, and Ariel Ludwig, Outpatient Services Manager for Valeo Behavioral Healthcare, right here in Topeka.

Glad both of you are here.

It's a serious topic, and I don't know the difference, I had never heard of, let's see, what are they calling this?

It's process addiction.

What is process addiction?

- So process addiction is this, it's kind of a newer terminology, traditionally speaking, addiction has been correlated with drugs and alcohol and other substances.

But as we have kind of evolved into the maturation of other usage, like internet, mobile phones, we've been able to categorize behavioral addictions as process addictions.

It's kind of that forthcoming that has created this language.

Normally speaking, they were just kind of behaviors that were problematic.

The DSM just recently, with the DSM-5, recognized gambling as addiction, and it's considered part of that process addiction.

Other addictions, pornography and those kind of things, and again, those kind of tie into the use of mobile phones and access to things.

So process addiction is kind of a subcategory of a thought process addiction that doesn't necessarily have any kind of chemical substance, but creates a behavioral need to engage in a trigger that would in fact release a reward system with all other addictions, and you can get hooked on that.

- Right.

And we'll get into the brain there too.

- [Ariel] Yeah, that's what I like.

- But you mentioned the gambling and gaming.

We have got to speak about this, Ronna 'cause we just came off March Madness.

Prior to that though, the Super Bowl, staggering statistics on how much was gambled at the Super Bowl.

- Yes.

$1.4 billion.

- [Betty] And that's billion with a B.

- Billion with a B, with a B, - Okay.

- Yes.

And that is actually the highest amount on record at this point.

So clearly, sports betting is becoming more and more available, accessible to everyone of all ages.

Whether you're looking at college campuses and sports betting around March Madness, as you mentioned, as far as with NCAA players, it's not just the brick and mortar casinos and bingo parlors anymore, there's so much more to it.

- Well, and let's get into that a little bit more, because it used to be, okay, "I'm betting my team will beat your team," but now it's like, "How many times when the chiefs play will the camera cut to Taylor Swift?"

- Exactly.

(Ariel chuckles) You can bet on just about anything.

Really, in my mind, didn't have anything to do with the game itself.

So I'm learning daily as well as what sports betting really entails.

- Well, and then like, you know, March Madness, we're talking about, okay, "How many three point shots in the first half made by their star player," or just... And the other thing is like, it comes on your phone, "Hey, you know, are you gonna bet on this?"

They've just made it so easy to lose money.

- Right, right.

And it's so enticing, you know, whether it's sexy people on the advertisement, whether it's, you know, "Bet $25, and your next bet you'll get a $200 bonus."

You know, so everybody loves a coupon or a discount.

- Sure.

- And so that's also part of the game.

- Yeah.

And Ariel, let's talk about the brain.

- Sure.

- You know, the reward system.

"Hey, I just won something."

Or it could even be like, "Okay, I just took that drink and now I feel great."

Talk about how the brain processes that.

- When you think about, dopamine is where everybody ties this idea of pleasure to, you know, dopamine gives us pleasure, yes, but it actually is somewhat, pleasure equals survival.

So when you do something that has an unpredictable nature, like gambling, if we're gonna take that for instance, it becomes a reward factor of unpredictability.

But when you win something, you didn't think you would win, but you did win, and so you tie the stimuli of, let's say, lights and casinos, or going on your phone, excitement, and that's all tied as a trigger to want you to engage in it.

And let's say it's your first time, let's just kind of run the course here.

So this is your first time, you go to a casino, you gamble and you win.

So the triggers and the stimuli created a plan and a preoccupation to create a routine, and then the routine was cemented by the dopamine and the pleasure.

So if you think about that, somebody may find that as like one of the most fun things and exciting things that they do, and if somebody wants to maintain that level of excitement, they may continue to do that behavior.

Or, sometimes when people are in stressful situations, they may not like the pain they feel, so they'll look for that as well.

So now these triggers become more abundant, and as we repetitiously do this, we start to form the addiction process of, when it's taken away, we feel pain, and that pain of loss and not being able to engage in something cause us to want to seek the pleasure once more.

- Right.

- So dopamine turns into survival, because even process addictions can have a chemical impact when it becomes an addiction, chemically speaking.

All addictions are psychological in nature, but they turn into somewhat of a chemical dependence.

- So let's go back to that, like, back in the day when there were Virginia Slim cigarettes and they had the little, you know, flowers and everything on the butt of the cigarette, and they portrayed that as being very glamorous.

But yet, with the addiction and things that were added to that, and they got people hooked on that, but we were able to overcome that.

What can we do now to overcome some of this that we're seeing, you know, you're addicted to your phone, you're addicted to gambling, you're addicted to whatever?

- Yeah, so I'm gonna be honest, there's lots of different therapies out there.

I will say though, that the advertisers, the marketers, the prop bets in gambling, the attractiveness, the dinging, we live by our phones, and we're hooked up at any times.

It's kind of like we're the antivirus system of trying to treat, but the hackers are still out there, like they're gonna be ahead of us.

So everybody will seek pleasure no matter what.

- And that form of communication is essential.

whether you're in recovery or you're struggling with an addiction.

- Right, if I'm feeling bad on a- - You're still gonna have your phone.

- Yeah, if I'm feeling bad on a Saturday and my phone lights up, I get a free bet, it's pretty easy to engage in that, right?

- You're going for it.

Right, right.

- But a person has to go through that, when I was talking about that pleasure, the consequences are usually where people change.

And the explanation when I say what that is, when the rewards, they're not greater than the negative consequences is when we see most change.

So the process addiction, just like any other addiction, has to cause some negative consequence.

Is it taking up too much time?

Am I financially broke?

I've lost loved ones?

Do people not wanna be around me if I'm angry all the time?

People have to be able to have awareness of their consequences, that's typically the start process.

And then when somebody's committed to change, there are types of therapy out there that do help.

You actually don't find that many therapists that treat it, but cognitive behavioral therapy has always been kind of the marquee way of treating this, kind of exposure response therapy.

You know, like, hey, put your phone aside, you know, spend this much gambling this week, or something like that, and kind of reduce, like a harm reduction.

That's kind of one of the traditional ways.

Cold turkey can work for a lot of people if the consequences are good enough, you know, if somebody says, "Hey, I'm leaving you if you keep gambling," that's probably enough for some people to stop.

- Right, right.

- And there's truth to that.

- But not enough for others.

- Any addiction requires enough negative consequences for the behavior to change.

- True.

- So let's go back to the casino, we were talking about that.

And I know that there's the billboards all over, "Gambling addiction?

Here's a number to call."

But yet, when you go in there, you're surrounded by lights, vibrant colors, the sound of, you know, the coins coming.

However, I noticed that when they quit kind of doing that at a lot of casinos, you don't actually hear the coins fall anymore making the sound, I know that was a big deal, but some people opt to do that, or opt to have that- - That stimuli.

- Yes, yes.

- And I think everybody reacts differently to different stimuli as well.

But you have to remember that the casino is a business, you know, they're there to make money, and then the house is who wins.

You know, at the end of the day, it's the house that's going to win.

Even if you look at it from a statistical standpoint, the house is the winner.

And with any addiction, you know, I use the analogy as far as, how do you know if something becomes an addiction, or is, well, you know, if a habit becomes an obligation, you know, then you're teetering on some concerns, and possibly some addictions.

But you know, everything starts with a habit, you know, some positive, some negative, but when it moves over to become an obligation is when it becomes an addiction.

You know, similar to what Ariel was talking about as far as the forms of treatment that are out there, there's all kinds of forms, whether it's inpatient, outpatient, intensive, you know, residential, there's all kinds.

And there is for problem gambling as well.

Which is also a business, in some respects.

So you do need to, at least in the state of Kansas, we have what we call, it's the 1-800-GAMBLER, it's the phone number, and when you make that phone call, you are calling a Kansas line, and those folks will get you to legitimate, reputable counselors.

And currently we have actually 46 in the state, so we are improving those numbers as well.

- I was impressed though, with the fact that we share with four other states- - We do, we do.

One thing that has become very apparent amongst the states, you know, each state has a different set of laws when it comes to gambling legally, you know, like Missouri, everything's on the water, and how it's structured is all different.

But we are part of what I would call a consortium with other states, Oklahoma, Nebraska, Iowa, Missouri, ourselves as well, we work very closely with them to make sure that, you know, people crossing from one border to the other are receiving treatment services in the right states.

You know, those kind of things, as well as being able to educate our neighbor too.

And looking at Missouri, you know, Missouri just has passed sports betting as well.

So, you know, for a long time people were crossing over to the border, to the Kansas side so they could, you know, place their bet and then go back home.

- I've done it.

- Sure, yeah.

(chuckles) - You know, people are savvy, you know, if you're struggling with an addiction, you're usually a pretty savvy- - [Ariel] Part of that preoccupation.

- Yeah, you know, that's what your focus is on.

- And you would never know who it is.

Like, if somebody's addicted to methamphetamines or something like that, you can often tell it in their appearance, their teeth or whatever.

Your elaborate read on that a little bit?

- Well, I wanted to scale back real quick on that, I think I failed to also mention the feelings that one has associated with their process addiction.

Touched on a good point that, you know, there's gambling hotlines to call, SAMHSA's always there to help too.

Any health clinic is helpful, you can type in anything, or there's outlets there.

But I think sometimes, one of the things that we need to be aware of is, some of these process addictions, though hard to identify, could be somewhat normalized for some people because it's legal, right?

Why would I have a problem?

Everybody else does it.

Like no big deal, right?

Or, the one that I think about and I used to treat a lot of, and I don't do as much anymore is, you know, pornography addiction, you know, that's also a process addiction.

But some of these addictions carry a lot of shame.

- Right, the stigma.

- The stigma next to that.

- And also, admittance to things that you've done behind people's backs.

And that can be hard, because some of these addictions are being closeted by people, and they're afraid that they have to tell the others that may be impacted by these.

There's always collateral damage with all these addictions, but until somebody gets attuned with their feelings, I mean, it's hard to process.

- Right.

And everything seems to have a financial element to it as well.

But that kind of gets back over here, because treatment through you is free.

- That's very true.

One of the benefits of also calling the 1-800-GAMBLER number and how we have the helpline available 24-7 set up directly with Kansas staff, it's staffed by Kansas folks, they are also able to, you know, hook you up with a problem gambling certified counselor at no cost.

- [Ariel] That's wonderful.

- You know, that is one thing that we do have that was put in place with our state, is the Problem Gambling and Addictions Fund, and those funds are used to pay for Kansas residents that are struggling with harms related to the gambling.

- And you know, people who gamble, I'm just so amazed at the statistics, it's like college-aged kids, you know?

That seems to be the biggest factor.

And I think it might be somebody, you know, a little bit older, but what's that all about?

- Well, what's interesting is, you know, the numbers are drastically rising at the college level with the sports betting.

I saw a statistic that said 67% of of college students that live on campus have placed a bet in the last week.

That even kind of threw me for a loop, and I thought I was reading all this stuff, you know.

- Well, and I saw that like, most people have two credit cards, but like a college kid or somebody who gambles might have 13 credit cards?

- Six to eight, yeah.

But when you look at the number of folks that are seeking treatment, it's more of an from a 40-to-55 age range.

Because those are the folks that have had enough negative consequences from the behaviors, whether that's having to file for bankruptcy, whether that's, you know, a spouse threatening to leave, like, you know, you had suggested.

There's many of the same consequences that come with both addictions, both types of addictions.

You know, I think with process addictions though, there's less telltale signs, I mean, you know, there's not necessarily visual signs.

You know, you don't see, oh, his eyes aren't bloodshot, you know, or he doesn't have met mouth- - Or his teeth are receding or something.

- Or, yeah, those kind of things.

You know, a lot of folks that are struggling with a problem gambling addiction, you know, are able to hold jobs.

And that's where we get into concerns around white collar crime and some of those things.

Because, you know, the idea is, there's embezzlement that comes up with that, and I'll embezzle from my business and I'll just pay it back as soon as I win big and, you know, there's all kinds of things people tend to tell themselves, yeah.

- Right, struggle.

And the homeless population.

I was surprised at how many homeless people gamble.

- Yeah.

I think it's the luck factor.

I mean, it could be a combination of boredom, but I think it's a luck factor.

Because I was saying, the interesting thing about like gambling itself, we're focused on this topic, it's like many of these process addictions, even if you don't win, they're addictive.

It's actually very common for people to have excitement at the idea of winning, let alone feel okay with losing and still get excitement.

It's a strange thing that a phenomenon that happens in the brain, and MRI studies have shown that.

So you can go, and if something's unpredictable and you have a chance of winning, it still can be fun.

And so I think the homeless population, when you really scale it down, it's like they're desperate, they might have won to scratcher ticket or two before, or they might have been to a casino and they won a few times, and they got 20 bucks, and maybe they can make 40, you know?

And the desperation brings out that need.

But when you think about the desperation, again, it's tied to the idea of that they have emotional pain because they're desperate.

And that causes a lot of pain, so you seek out pleasure to accommodate that pain.

- I'm kind of starting to worry about kids too.

Like, you know, of course Candy Crush, right?

You know, that can be addictive.

- [Ronna] The correlation between gaming and gambling.

- Oh, yeah.

- Yeah.

And bingo, you think that that's not necessarily addictive, but let's talk about when you go into a bingo parlor, or maybe you have your little lucky charm, or, elaborate on that a bit.

- Yeah, I mean, and I think backing up a little bit, as far as, you know, normalizing behaviors as adults, our kids see us mirror that, you know, that they'll mirror what we do.

And you know, if we're thinking, oh, let's buy a bunch of lottery tickets and put it in the kids' stockings, you know, maybe they'll have fun scratching 'em, or, you know, pulling 'em off their pull-tabs or whatever.

- [Ariel] Then they win and we all get excited for him.

- Yeah, and it's like, oh, darn, we lost.

You know?

And it's this concern or whatever.

But as far as, you know, the bingo hall and the Lucky, everybody thinks they have, you know, they walk into the casino and this machine is calling me, or, you know, the mind can play wonderful tricks on, it's a talent and a skill that the mind is able to do.

I mean, and that's a survival technique as well.

You know, I would love to be able , if I was ever, you know, crashed in a helicopter and things weren't good, and I didn't have a drink of water and I needed one, and I could tell myself, "I'm not thirsty, you just had a drink," you know, there's all kinds of things.

- Mind tricks.

- The mind tricks, you know, whether they're realistic or reality or not, you know, you go into a bingo hall and everybody's got their dabbers, you know, for their game lined up in a certain order, or, you know, and it's very important that they sit on the left side of the green table.

- [Ariel] (chuckles) Right.

- You know, I've heard all kinds of things.

You know, or I have my lucky feather with me, or I have my- - Superstition is strong.

- You know, or I have my lucky little- - Very strong.

- You know, Yoda doll.

- Or, in a casino I've heard like, if the cute girl sits on the end of the row, that'll hit, because then she'll be excited and then everybody will rush over and think, okay, she did it, so I can too.

- You know, whether it's the sounds, or it's the colors, the lighting, everything- - The people, the excitement.

- That environment, you know, that environment is staged very much, you know, for that kind of thought process.

- And as we were talking earlier about, you know, we've got celebrities, and they look glamorous, and they're going on and off.

So how do you deal with that at Valeo, for example?

- So when you have, rephrase that for me?

- Right.

Well, you know, when somebody comes in and they say, "Oh, I just can't get enough of this, I just," you know.

- Yeah.

I want to just kind of say like, that stimuli, what brings someone into something is kind of like, if you work backwards, you can kind of find that out when you work with somebody at Valeo or any of these health centers, you want to somewhat explore the idea.

You're not telling somebody they can't do something, but you're validating what they're doing, and you're trying to navigate... Motivational interviewing is kind of like the really first step for working with people, it's this idea of rolling with the resistance, engaging the person, allowing them to speak their voice to you.

It's not that you can't do this, you can't do that, but it's idea of rebuilding that rapport.

- Right.

Non-judgmental.

- Non-judgmental.

Old school therapy ideas.

The most important thing is relationship and relationship, and you all can guess what the next one is.

- [Betty] Relationship.

- I'm not playing a joke.

Yeah, it's relationship.

It's this idea.

And if you can build that with somebody, as somebody gets that out of their heads and they¡re able to validate and get concerned, or somebody to listen, and you say, "Hey, you know, I get it," they start to kind of circumvent their own process, and they can come up with a conclusion like, "I do have a problem, and I do want some help."

I think when you think about somebody coming in for an addiction, the things that they've heard is, "You can't do this.

you can't do this, you're destroying my life, you're not doing things right."

And so once you put them on the offensive, or you get offensive, they're defensive.

- Right, they're defensive.

- To rephrase that.

They'll leave, you won't be able to help them.

You have a moment of time to use that motivational interview, the empower, engagement, collaborate with them, and then typically they kind of come to their own surface.

So it's not quick, everybody wants it done right away, you can't just get somebody to stop gambling in one session.

Now if you do, you're great, and it can't happen, but it's an anomaly.

It's a process, just like the addiction.

And there's no perfection, 'cause there is gonna be relapses, and you have to use those.

It's not like, oh, it's not that big a deal, It's more like, let's do an autopsy, let's look at this.

What happened?

- You're offering hope.

You're offering hope.

- Right.

- It's that short window of time that you can offer hope and the potential for what could be.

- Yeah.

And that's what you kinda have to do.

But you have to be willing to work with the person too.

You have to have an open mind, and you have to be okay with the idea that if you don't know something, it's okay, you can listen, you can figure it out later.

Because process addictions aren't treated that well right now, and there's not that many therapists out there that do it.

Johnson County has quite a few, but in this general area, I haven't seen as many.

And so, there is hope.

There are groups too, you can find groups, you can type it in, you can find some groups.

If you talk to, you know, Meeting Guide app, it's a great app, you can find local things for process addiction.

- Gamblers Anonymous, just like you've- - Gamblers Anonymous.

- I'm hearing that AI is even getting involved in this.

- Well, yeah, AI is gonna get involved.

- [Ronna] Getting involved in everything.

(chuckles) - They're gonna be another addiction.

- [Betty] I know.

- Yeah, but, you know, and I was just like, I always do this with people.

One of the first things is when I'm talking to somebody and I say, you know, "When you see something you want and you desire it strongly, you might seek it."

We carry our phones wherever we go.

So of course when we talked about younger people, you know, they're glued their phones, it's easy for them to gamble.

But when I also say, "I'm gonna take that away from you," you still think about it.

Like, I could shove this cup in somebody's face and say, "Don't look at the cup," and they're gonna look at the cup.

- [Betty] That's usually where you're gonna go.

- Yeah.

- It's like, "I'm only gonna eat one M&M."

- Yeah, it's like, well- - But you can't eat just one.

- Well, you can't eat just one.

- Like potato chips, yeah.

- It's hard, yeah.

- They know what they're doing.

- Yeah.

- Yeah.

So, I mean, addiction's difficult, but I think that's when the motivational interviews, they could start listening, validating, empowering.

People are capable of sorting out their own issues as long as you help guide them, and that's the trust that you have to have with them.

But you won't be a hundred percent successful, and that's okay too.

(uplifting music) - Thank you both so much for being here.

Whoa.

That's all we have time for this episode of "IGI."

If you have any comments or suggestions for future topics, send us an email at issues@ktwu.org.

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For "IGI," I'm Betty Lou Pardue, we thank our guests, and we thank you for watching.

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Thank you.