Durand F. Jacobs

A General Theory of Addictions: A New Theoretical Model

A general theory of addictions is proposed, using the compulsive gambler as the prototype. Addiction is defined as a dependent state acquired over time to relieve stress. Two interrelated sets of factors predispose persons to addictions: an abnormal physiological resting state, and childhood experiences producing a deep sense of inadequacy. All addictions are hypothesized to follow a similar three-stage course. A matrix strategy is outlined to collect similar information from different kinds of addicts and normals. The ultimate objective is to identify high risk youth and prevent the development of addictions.

Evidence for a Common Dissociative-Like Reaction Among Addicts

A questionnaire was designed to test selected aspects of the authors General Theory of Addictions (Jacobs, 1982). Data were collected from groups of compulsive gamblers, alcoholics, and compulsive overeaters, and compared with the responses to the same questionnaire obtained from normative samples of adolescents and adults. The more inclusive term, “compulsive gambler,” has been used throughout, since the sample of gamblers in this study included an inpatient subgroup who had been diagnosed as “pathological gamblers,” as well as a subgroup of Gamblers Anonymous members who had not been clinically evaluated. Findings support the authors theoretical position that, when indulging, different kinds of addicts will tend to share a common set of dissociativelike experiences that differentiate them from nonaddicts. This has been termed a “state of altered identity.”

Children of problem gamblers

An anonymous 37-item Health Survey was administered to 844 randomly selected ninth- to twelfth-grade students in four Southern California public high schools. Systematic information was gathered about their general health, quality of life, school and work adjustment, involvement with a range of potentially addictive substances and activities, and indications of psychosocial maladjustment, including difficulties with the law and suicide attempts. A series of self-ratings of students who characterized one or both of their parents as having a compulsive gambling problem (N=52) were contrasted with those of their classmates who reported no gambling problem among their parents (N=792). Findings have been grouped into three major areas: (a) comparative levels and reported effects of involvement with health-threatening behaviors (i.e., smoking, drinking, drug use, overeating, and gambling); (b) comparative incidence of psychosocial risk indicators (i.e., broken home, unhappy childhood and teenage years, legal action pending, overall quality of youth rated as “poor”); and (c) comparative incidence of dysphoria, school and work problems, and suicide attempts. Across each of these areas children of parents said to gamble excessively were found to be at consistently greater risk than their classmates who did not describe their parents as having a problem with compulsive gambling. These findings strongly suggest that without early and competent intervention, children of parents who gamble excessively: (a) will be seriously disadvantaged when attempting to solve their present adolescent and future adult problems of living; and (b) as a consequence are, themselves, high-risk candidates for developing one or another form of dysfunctional adjustment, including an addictive pattern of behavior.

The Incidence of Pathological Gambling among Native Americans Treated for Alcohol Dependence

The prevalence rate of potential and pathological gambling was examined among Native American and Caucasian patients (n = 85) being treated for alcohol dependence. Previous studies with alcohol-dependent (mainly Caucasian) populations revealed 10-15% to have gambling problems. This study, the first to measure pathological gambling among a Native American population, utilized the South Oaks Gambling Screen and was administered in a group setting, between 1/91 and 4/91 on the alcohol treatment ward of the Ft. Meade Veterans Administration Hospital. Results showed that 22% of the Native Americans studied (compared to 7.3% Caucasian), scored in a range indicating a probable pathological gambling addiction. Furthermore, 41% of the Native Americans studied (compared to 21.3% Caucasian) admitted to some difficulty with gambling. Education and treatment is encouraged to help stem projected radical increases in pathological gambling and related problems among this cultural group as Native American gambling becomes widespread.

Sexual Risk-Taking Behaviors, Gambling, and Heavy Drinking Among U.S. College Athletes

The purpose of this study was to empirically examine the prevalence patterns of sexual risk-taking behaviors (i.e., unprotected sex and having multiple sex partners) in relation to levels of gambling problems and heavy episodic drinking (HED) status among U.S. college athletes. Data from a representative national sample of 20,739 U.S. college athletes were derived from the first National Collegiate Athletic Association national survey of problem gambling and health-risk behaviors. Among college athletes who were sexually active during the past year, males reported significantly higher prevalence of unprotected sex (10.2%) and multiple sex partners (14.6%) than females (7.9% and 9.3%, respectively). Using the DSM-IV Gambling Screen classification, as the level of gambling severity increased, the prevalence of sexual risk-taking behaviors also increased among female athletes, but decreased among male athletes. As regards the effect of heavy drinking, while both male and female HED athletes reported elevated sexual risk-taking, the effect of HED was twice as large in females as in males. It is important to note that the definitions of sexual risk behaviors in this study took into account committed sexual relationship status; hence, the results of this study need to be interpreted with the refined sexual risk measures in mind. Further investigations are warranted to help us better understand and explicate the interrelationships of sexual risk-taking behaviors, gambling, and heavy drinking among these college athletes. Findings from this exploratory study suggest new directions for future research and practice and also highlight the importance of a more inclusive multi-component approach to address these co-occurring youth risk behaviors.

Gambling Behavior Among College Student-Athletes

Analyzing data from a representative sample of 20,739 U.S. college student-athletes, this study sought to determine whether certain student-athletes were more prone to frequent or problem gambling behavior. Relative to other studies of college students, a lower percentage of National Collegiate Athletic Association (NCAA) student-athletes reported gambling (males 62.4%, females 43%) and having gambling problems (males 4.3%, females 0.4%), but a high prevalence of weekly gambling was reported (males 13.0%, females 3.3%). Male student-athletes in high profile sports (e.g., baseball, football) were more likely to report a gambling-related problem compared to their counterparts in other sports (e.g., track & field, volleyball). Sports wagering remains a cause for concern. Only a very small number of student athletes reported major infractions such as attempting to alter the outcome of a game or sharing inside information. Future research should investigate why certain student-athletes are more prone to develop gambling problems.

DSM-based problem gambling: Increasing the odds of heavy drinking in a national sample of U.S. college athletes?

Despite previously found co-occurrence of youth gambling and alcohol use, their relationship has not been systematically explored in a national sample using DSM-based gambling measures and multivariate modeling, adjusted for potential confounders. This study aimed to empirically examine the prevalence patterns and odds of at-least-weekly alcohol use and heavy episodic drinking (HED) in relation to various levels of gambling severity in college athletes. Multivariate logistic regression analyses were performed on data from a national sample of 20,739 U.S. college athletes from the first National Collegiate Athletic Association national survey of gambling and health-risk behaviors. Prevalence of at-least-weekly alcohol use significantly increased as DSM-IV-based gambling severity increased, from non-gambling (24.5%) to non-problem gambling (43.7%) to sub-clinical gambling (58.5%) to problem gambling (67.6%). Multivariate results indicated that all levels of gambling were associated with significantly elevated risk of at-least-weekly HED, from non-problem (OR = 1.25) to sub-clinical (OR = 1.75) to problem gambling (OR = 3.22); the steep increase in the relative risk also suggested a possible quadratic relationship between gambling level and HED risk. Notably, adjusted odds ratios showed problem gambling had the strongest association with at-least-weekly HED, followed by marijuana (OR = 3.08) and cigarette use (OR = 2.64). Gender interactions and differences were also identified and assessed. In conclusion, attention should be paid to college athletes exhibiting gambling problems, especially considering their empirical multivariate associations with high-risk drinking; accordingly, screening for problem gambling is recommended. More research is warranted to elucidate the etiologic mechanisms of these associations.

Holistic Strategies in the Management of Chronic Pain

Years of faulty problem definition have added significantly to the ranks of 40 million chronic pain sufferers in the United States. The isomorphic conviction that persistent pain complaints must be based on some underlying organic pathology has led well-meaning clinicians inadvertently to incur drug addiction, to surgically augment pain, to foster functional invalidism and to further dislocate the lives of chronic pain sufferers and their families. The economic toll of lost wages, medical costs and related expenses, and compensation payments is estimated to be as high as 35 to 50 billion dollars a year. The extent of mismanagement of chronic pain patients has reached the proportion of a national tragedy.