Understanding the means and objects of addiction: Technology, the ...

Understanding the Means and Objects of Addiction: Technology, the Internet, and Gambling H o w a r d J. S h a f f e r , P h . D . , C.A.S. Harvard Medical Schoo~ Division on Addictions

This article describes how using new computer technology and the Internet for gambling can represent both the means and object of addiction. However, these technological factors do not represent the cause of addictive behavior. Given the widespread availability of computer technology and the remarkable expansion of the Internet, it is not surprising, however, that these technological advances have become associated with intemperate gambling activities. By discussing the concept of addiction and its associated social setting, neurochemistry, and gaming characteristics, this m-tid e suggests that addiction is the result of shifts in subjective experience and that new technology and the I n t e m e t can provide relatively reliable and potent contemporary vehicles for changing emotional states.

New c o m p u t e r technology is the means by which gambling is delivered to homes, businesses, and airplanes. C o m p u t e r users require this new technology to access and maintain the Internet, which is a vast network that serves as bot h a communication system and a repository of information. During 1995, the Internet came to be regarded as a new "mainstream" communication vehicle for the general public (Chapman, 1996). Researchers estimate that there are 13 to 15 million Int ernet users in North America and 20 to 25 million users around the world Special thanks are extended to Joni Vander Bih, Matthew Hall, and Gregory O'Donohue for their helpful comments on earlier versions of this article. Send reprint requests and correspondence to Dr. Howard J. Shaffer, Division on Addictions, Harvard Medical School, 220 Longwood Avenue, Boston, MA 02115.

Journal of Gambling Studies Vol 12(4), Winter 1996 9 1996 Human Sciences Press, Inc.

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(Chapman, 1996). By combining an expansive n u m b e r of Internet users, credit cards, and new computer technology, access to gambling has b e c o m e easy. The Internet permits casino type gambling to become ubiquitous. Without a specific jurisdiction responsible for its activities, Internet gambling is difficult to regulate (National Association of Attorneys General, 1996). "Gambling once involved clandestine dealing with unsavory bookmakers . . . . Innovators are using technology to extend the frontiers of gambling-often to the frustration of regulators" (Bulkeley, 1995, p. 1). In addition to regulatory problems, there is a growing public concern (e.g., Jabs, 1996; O'Neill, 1995) that new technology may increase gambling addiction. Murray (1996) described the general problems of c o m p u t e r addiction for students. This article will explore the relationship between technology and addiction by using the Internet and gambling as contemporary examples of the means and the object, respectively, of potentially self-destructive, repetitive behaviors.

UNDERSTANDING T H E C O N C E P T OF ADDICTION T o begin this exploration, we must first take a digression and come to some a g r e e m e n t about what is meant by addiction. This is a daunting task, however, since there is considerable confusion about the nature of addiction (e.g., Shaffer, 1986; Shaffer, in press). Most theoretical explanations of addiction are provincial, attending only to the unique characteristics associated with specific objects (e.g., alcohol, heroin, cocaine, lottery) and a narrow pattern of behavior (e.g., alcoholism, heroin dependence, cocaine dependence, pathological gambling). As the opportunities to engage in potentially addicting activities (e.g., gambling) become more prevalent because of widespread access, a m o r e cosmopolitan model of addiction will be necessary to help us understand the role that new and emerging technology plays in initiating, expediting and sustaining addictive patterns. Currently, there is conceptual chaos surrounding the notion of addiction (e.g., Shaffer, 1986; Shaffer, in press). Clinicians, researchers, and social policy makers are without a shared definition of addiction. For example, addiction does not appear as a concept in any contemporary diagnostic manuals. Absent a mutually agreed u p o n definition of addiction, clinicians and social policy makers often are left to debate whether patients who use drugs also "abuse" drugs. Similarly, "heavy"

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gamblers remain difficult to distinguish from "pathological gamblers." Treatment programs regularly mistake drug users and "abusers" for those who are drug dependent. Similarly, bad luck "heavy" gamblers can be mistaken too easily for pathological gamblers. Too often the result of this confusion is unnecessary hospitalization, increased medical costs, and patients who learn to distrust health care providers. Alternatively, absent a precise definition o f addiction, some people fail to receive the care they require. As a result of these complex conceptual conditions, practice guidelines in the addictions are equivocal and health care systems experience management and reimbursement chaos. Addiction with Dependence and Without Dependence: Substances and Processes. Even under most established constructions of addiction, not all drug dependent patients evidence addictive behavior. 1,2 For example, in most civilized countries, under nearly all traditional circumstances, people who are nicotine d e p e n d e n t do not evidence addiction. In spite of nicotine dependence, when cigarettes are readily available, smokers rarely express themselves with anti-social behavior patterns or resort to illicit activities. However, when tobacco is recast as a socially unsavory or legally illicit substance, addictive behavior patterns have emerged (e.g., Reuters News Service, 1992). Similarly, many post-operative patients receive sufficient quantities of narcotics as analgesic medications to produce some level of physical dependence. However, in spite of their neuroadaptive experiences (i.e., tolerance and withdrawal), the overwhelming majority of these patients never display addictive behavior toward narcotics. Complicating matters, physical dependence is not necessary for the notion of addiction to apply. For example, u p o n stopping, pathological gamblers who do not use alcohol or other psychoactive drugs can reveal physical symptoms that appear to be very similar to either narcotics, stimulants, or poly-substance withdrawal (e.g,, Shaffer, Hall, Walsh, & Vander Bilt, 1995; Wray & Dickerson, 1981). Perhaps the patterns and frequency of excessive behaviors are more important than the objects of these acts.

1Although a full discussion of this matter is beyond the scope of this article, it also is important to note that not all people with addiction are impaired in every aspect of their daily life. Despite s o m e exceptions, substance addictions tend to be m o r e broad spectrum disorders while pathological gambling tends to be a more narrow spectrum disorder.

'~'his notion of addiction includes a shifting priority of behaviors so that those once having priority lose value while others gain ascendancy;, in addition, since these new patterns include anti-social behaviors, illicit activity is present on occasion.

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If addiction can exist both with and without ingesting exogenous drugs--as is the case with gambling-then the concept of addiction must be sufficiently broad to include human predicaments that are related to either substances or activities (i.e., process addiction). Although it is possible to debate whether we should include both excessive substance or process disorders within the conceptual domain of addiction, technically there is little choice.Just as exogenous substances precipitate impostor molecules vying for receptor sites within the brain, other activities (i.e., not related to drug taking) can also stimulate naturally occurring neurotransmitters (e.g., Hyman, 1994; Hyman & Nestler, 1993; Milkman & Sunderwirth, 1987). The effects of these naturally occurring psychoactive substances likely will be determined as the mediating cause of many process addictions as neuroscience researchers investigate the biochemistry of the brain.

T H E NEUROCHEMISTRY OF ADDICTION: SHIFTING SUBJECTIVE STATES If addiction can exist both with and without physical dependence, then we can advance addiction theory by considering the objects of addiction to be those things or activities that reliably and robustly shift subjective experience. The most reliable and robust "shifters" hold the greatest potential to stimulate the development of addictive disorders. Psychoactive drugs, gambling, and certain other activities will correlate highly with shifting subjective states because these activities reliably shift subjective states. The strength and consistency of any activity to shift subjective states will vary across individuals. In spite of this variation, psychoactive drug use and gambling are sufficiently reliable shifters of subjective states that this model will continue to rank these experiences high a m o n g the array of activities that can become the objects of addictive behavior.

OBJECTS OF ADDICTION: CAUSE, CONSEQUENCE, OR RELATIONSHIP To this point, I have implied tacitly that simply using drugs or gambling does not cause addiction. Now let me be explicit: from a

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logical perspective, the objects of addiction cannot cause addictive behavior patterns. The teleological aspects of the current conventional wisdom about addiction theory and practice contribute much to contemporary conceptual chaos. To illustrate, if using a drug was a necessary and sufficient cause for addiction, then addiction would occur every time this drug using pattern was present. Similarly, if drug using was the only necessary and sufficient cause for addiction, addictive behaviors would be absent every time drug using was missing. Nevertheless, as I described before, both neuroadaptation and pathological gambling are often present when drug using is absent. Therefore, drug using is neither a necessary nor a sufficient cause to produce addiction. Furthermore, it may not even be the primary cause of addiction. Even though drug using is highly correlated with addiction, because psychoactive substances reliably shift subjective experience, drug taking does not cause addiction. As in the case of pathological gambling and excessive sexual behaviors that do not fall within the domain o f obsessive compulsive disorders, addiction can exist without taking drugs. This observation provides insight into the necessity for considering a more complex relationship between a person who might develop addiction and the object of their dependence. It is the relationship of the addicted person with the object of their excessive behavior that defines addiction. It is the confluence of psychological, social and biological forces that determines addiction. No single set of factors can define addiction precisely (e.g., Shaffer, 1987, 1992; Zinberg, 1984). Unfortunately, the concept of relationship is difficult to define. Therefore, until experience provides more insight into the synergistic nature of these factors and helps us to determine the interactive threshold(s) that may apply, we operationally define addiction so that researchers, clinicians and policy makers can share a c o m m o n perspective (Shaffer, 1992; Shaffer & Robbins, 1991; 1995).

T H E SUBJECTIVE EFFECTS O F GAMBLING: GAME, SET, SETTING The most common conceptual error committed by clinicians, researchers and social policy makers is to think that addiction resides as a latent property of an object (e.g., a drug or game of chance). Conventional wisdom refers to "addictive drugs" or "addictive gambling."

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However, addiction is not the product of a substance, game or technology, though each o f these things has the capacity to influence h u m a n experience. Experience is the currency of addiction. Addiction is the description o f a relationship between organisms and objects within their environment. Consequently, the causes of addiction are multifactorial (e.g., Zinberg, 1984). The experience of gambling--whether buying lottery tickets at a convenience store, placing a bet on the floor of a casino, placing a wager on the next race, or using credit cards to gamble at a web site on the Intemet--is a function of the psychological "set" of the gambler, the "setting" within which the gambling occurs and the "game" that is played. In this case, set refers to the psychological expectations of the gambler, including their personality and cognitive style. The setting refers to the immediate social environment within which one gambles as well as the influences exerted by the more distant social mores, folkways and cultural context. The game refers to the specific activities involved in playing a particular game (e.g., the speed, rules of play, articles, risk reward ratio, player demands, etc.). These three interactive factors determine the subjective experience of every gambling activity. There is considerable subjective variation among gamblers. For example, some people only like table games and others only sports betting. Perhaps more interesting is the variation that occurs within an individual: the same person, playing the same game, will experience different subjective states on various occasions because their set and setting vary. This circumstance makes it difficult to predict with precision who will develop addictive disorders. In every instance of shifting technology, people require the opportunity to adapt to the unexpected subjective states associated with using the new technology. The invention of the hypodermic syringe during the middle 19 ta century ushered in an era of narcotics addiction (Courtwright, 1982); when users developed the technology that permitted smoking instead of chewing cocaine, they increased the potency of this stimulant and started an era o f cocaine abuse. When tobacco became available in pre-rolled cigarettes and no longer required ritualistic preparation, excessive smoking patterns increased (e.g., Zinberg & Fraser, 1989; Zinberg, 1984). Now, as computers attract m o r e people to the Internet for collecting information or gambling, this technology is changing how people learn and play; these new activities mark the beginning of unaccustomed experiences. These new experiences are dif-

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ficult to regulate precisely because the subjective state is novel. New opportunities to gamble using the Internet, computer technology and other electronic means require people to adapt to these unprecedented experiences. Adaptation to Promethean events requires time. Just as it has taken decades to begin adjusting to the adverse consequences of post-prohibition alcohol use, it will take time to learn how to relate to computer technology with temperance. In spite of the inevitable problems associated with the use of new technology, we should not mistake the technological means o f gambling with the objects of addiction. We also should not think that addiction is a property of computers, technology, or electronics. The final pathway for all of the addictions is not the object of addiction (e.g., as many believe drugs are "addictive"). The final c o m m o n pathway for addiction is always subjective experience. The organ o f subjective experience is the brain with all of its associated neurochemistry. Activities that reliably shift human experience hold addictive potential. This will vary from person to person and from m o m e n t to m o m e n t for the same person. Epstein (1989)described the subjective experience of shifting brain neurochemicals (e.g., increased dopamine) by gambling. "Gambling is personal. It is associated with our status in life. No activity has been more rationalized than gambling--odds figured, probabilities worked out, point spreads meticulously established--and no activity, surely, is finally more irrational. In this essentially irrational activity, the first item that must be fixed, and with some precision, is the stake. Above all, it cannot be too little; it must be enough to stimulate whatever those spiritual glands are that gambling calls into action. The punishment must fit the crime; the agony of losing must be roughly equivalent to the ecstasy of winning. In this sense, it becomes clear that no bet can ever be too large; and herein lies the madness inherent in gambling, for the more you have, the more you need to risk" (Epstein, 1989, p. 100). H u m a n vulnerabilities for consciousness shifting have been identified. For example, chronic and acute emotional pain enhances factors that encourage the dissociative, pain relieving, characteristics of gambling. In addition, exciting new findings reveal a genetic propensity for novelty-seeking personality traits (Benjamin et al., 1996; Ebstein et al., 1996). The interactive characteristics of novelty seeking as an analgesic consciousness changing activity increase the potency and reliability of the Internet as a shifter of subjective experience.

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H O W DOES GAMBLING, C O M P U T E R T E C H N O L O G Y , AND T H E I N T E R N E T INFLUENCE SUBJECTIVE EXPERIENCE O n e o f the great allures of gambling is its capacity to excite, entertain, and help people forget their everyday problems. In this capacity, Jacobs (1989) considered gambling to be a dissociative experience. Computers have the capacity to stimulate the intellect and excite the spirit. The Internet is a connecting web of computer sites. It is a system of technological bridges woven together electronically to provide an enormous repository o f information. The Internet is a vehicle for gathering resources and communicating with others. Using a computer, like narcotics, often accelerates the subjective passage of time. Many beginning users find themselves spending more time than anticipated in front of a keyboard and monitor. Technological neophytes and experienced users alike know the feeling of getting lost in the intellectual substance of cyberspace. Accessed by computer, the Internet provides users with the opportunity to escape from one state of consciousness and visit different worlds of information with all the euphoric mind-bending properties associated with new adventures and problem solving. Accessing and navigating the Internet provides users with a sense of competency and control as they explore new worlds of information. With remarkable swiftness, visitors to the Internet can take on themselves the roles of explorers who sail ("surf") the high seas in search of new territories. The Internet has no inherent addictive properties; however, it does have the capacity to stimulate our senses and shift our subjective state. The results of these experiential shifts can be positive (e.g., education) or negative (e.g., addiction).

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