Self-Medication
Today’s agenda
House Keeping
Self-Medication, Trauma, and the Female Gambler
Self-Medication
Drugs push aside suffering
How should we be able to forget those ancient myths... about dragons that at the last
minute turn into princesses who are only waiting to see us once and beautiful and
brave?... [P] erhaps everything terrible is in its deepest being something helpless that
wants help.
Rainer Maria
Rilke
Hurt: Cash Covering Nine inch Nails...
Nicotine’s the World’s Antidepressant
5 million premature deaths associated with tobacco use in 2000
It is estimated that between 2025 to 2050 there will be 300 million tobacco deaths
Why do we use it? Is it self-medication?
Effects on the brain
Dopamine, GABA, MAO
DiFranza (2008) suggests that it may only take a month to become hooked
Nicotine and Canadians
45,000 Canadians die each year from smoking related deaths each year
For long-time smokers, the chance of dying from a smoking-related cause is 50%
Smoking is the single most preventable cause of cancer (Lung Cancer Canada, 2008)
Check this out
Gender Differences in Alcohol Use
Men have higher lifetimes rates of alcohol disorders
However, women appear to surpass men in alcohol related problems, such as
Deaths from suicide
Alcohol related accidents
Heart disease and stroke
Cirrhosis of liver
Post-traumatic Stress Disorder & Self-Medication
Early research centred trauma and PTSD as an effect of war, civil war - “soldiers heart”; world
wars - shell shock
Today in the aftermath of 911 and closer to home residential school aftermath, trauma and PTSD
is becoming more recognized
We have now beginning to challenge the etiological diagnosis where the traumatic event is
thought to be “outside” the normal range of experience - to realize that rape, battery, sexual and
domestic abuse, are so common that they can “hardly be outside” the range of normal experience
The Heart of PTSD and Trauma
According to Herman (1997) - Intense emotional reaction to an event - panic, terror, grief or
disgust
According to National Center for PTSD (2007) those most likely to develop PSTD
DIRECTLY EXPOSED
SERIOUSLY INJURED IN THE EVENT
LONG LASTING AND SEVERE
BELIEVED LIFE IN DANGER
BELIEVED FAMILY MEMBER WAS IN DANGER
SEVERE REACTION DURING EVENT
FELT HELPLESS FOR ONESELF OR FAMILY MEMBER
HAD EARLIER LIFE THREATENING EVENT
DRANK ALCOHOL IN EXCESS
RECENT UNEXPECTED LOSS
Reign over Me: A Trauma Example
PTSD SYMPTOMS
PTSD begins can begin intensely and can wane, and wax, and wane.
Psychological symptoms include
Re-experiencing (flashbacks, nightmares, intrusive memories)
Emotional Numbing (feeling detached, lack of emotions, loss of interests
Avoidance (activities, people, or places that are reminders of trauma)
Increase arousal (difficulty sleeping, irritability, hyper-vigilance, exaggerated startle
response)
Psychological outcomes can include the following:
Depression, major or pervasive
Anxiety disorders, phobias, panic, and social anxiety
Conduct disorders
Dissociation
Eating disorders
Psychosocial manifestations
Alcohol and substance abuse
Suicide attempts
Risky sexual behaviours
Self-injury
Interpersonal problems
PTSD and Substance Abuse
Kimmerling et al. (2004) report that approximately 30% to 50% of men and 25% to 30% of
women with lifetime PTSD are also substance abusers
Those with SUD and PTSD have poorer substance abuse outcomes (Brown, 2000)
Meanwhile those with PTSD relaspe more quickly, drink more on days when they drink, have
greater % of heave drinking days and more consequences due to non-PTSD substance abusers
(Brown, 2000)
Women are more likely to develop addictions after exposure to traumatic event and symptoms of
PTSD, with approximately 65% to 84% of women experiencing PTSD before developing
addictive dependencies (Milkman & Sunderwirth, 2008)
Meanwhile, men appear to develop PTSD symptomology during their addictive careers
(Kimmerling et al. 2004)
Trauma, its Role and Trajectory in the Development of Female Pathological Gambling
An Interpretative Phenomenological Analysis
Setting the Context
There is a paucity of research that addresses the connection between trauma and female
pathological gambling (Boughton & Brewster, 2002).
However, research has revealed that a large percentage of individuals with mental health
problems report having experienced a traumatic event (Larkin & Morrison, 2006).
Women in particular, are at a greater risk of being exposed to trauma that sometimes occurs in
close relationships (Wolfe & Kimerling, 1997) (i.e., incest, marital and date rape, and intimate
partner violence).
Then again, it is not known whether pathological gambling development and its progression can
be related to the latter kinds of traumas.
Previous Research
Based on a Canadian study involving both males and females living in 22 families, Grant
Kalischuk and Cardwell (2004) developed a grounded theory that situated trauma as
being a factor implicated in problem gambling for both males and females.
Afifi, Brownridge, MacMillan & Sareen (2010) sought to understand the relationship
between problematic gambling and family violence. Results from their study suggested
problem gambling may be directly associated with dating violence, marital violence and
child abuse.
In a sample of 111 pathological gamblers, Kausch, Rugle, and Rowland (2006) identified
a relationship between gambling and trauma, however the role that trauma played in
development of these 111 pathological gamblers was not determined. With respect to
gender, the sample was comprised of only 9 female participants and yet all 9 reported
emotional, physical or sexual abuse or multiple abuses.
Previous Research (contd)
In a more representative sample, Petry and Steinberg (2005) studied childhood
maltreatment in male and female treatment-seeking pathological gamblers, recruiting
participants from seven treatment sites (N= 149; 77 females and 72 males).
The authors found that gender was specific to the intensity and types of childhood
maltreatment experienced. It was revealed that female gamblers had higher scores
related to sexual/emotional abuse and physical neglect.
An important consideration pointed out by the authors was that the study “did not
address whether childhood maltreatment leads to pathological gambling” (Petry &
Steinberg, 2005, p. 228).
What we know about Trauma and Gender!
Among survivors of abuse, research has consistently documented increased rates of
psychiatric disorders (Kessler, Sonnega, Bromet, Hughes & Nelson, 1995).
According to Strachan and Custer (1989) and Lesieur and Blume (1991) as well as
others, gambling has been categorized as a means for dealing with trauma and traumarelated abuse (via escape), especially among females.
Half of Canadian women (51%) have experienced at least one incident of physical or
sexual violence since the age of 16 (Statistics Canada, 2006). Moreover, the World
Health Organization (WHO, 2006) have recognized that gender is a well known
determinant in a variety of health-related problems and that differences exist between
male and female treatment utilization, substance use, and mental health-related
symptoms and diagnoses.
Linking Trauma to Women Gamblers
Interestingly, among 365 females gamblers from across the province in Ontario,
Boughton and Brewster (2002) found that 46% of women reported experiencing physical
abuse as adults and 28% reported experiencing sexual abuse as an adult, while another
30% of married participants reported current physical abuse in their relationships.
However, despite determining that gambling was a means by which the individual was
able to escape from life stressors, the mechanism by which trauma played a role in the
development of problem gambling continues to remain under-investigated (Boughton &
Brewster, 2002).
Today’s Presentation
This presentation will focus on essences drawn from a phenomenological interpretative
investigation of 6 women (taken from a larger grounded theory study of 40 women)
(Kalischuk, Nixon, Hagen, & Solowoniuk, in press) who self-reported having a
traumatic history and whose scores on the NORC DSM-IV gambling screen indicated a
severe problem with gambling.
Method: Interpretative Phenomenology (IPA)
IPA endeavours to provide a descriptive account of a participant’s world that is both
critical and conceptual leading to a life text that supports participant claims and feelings
about a lived experience (Smith, 1996).
What makes IPA unique from other qualitative methods is its position on constructing an
interpretation derived from investigated experiences (Larkin, Watts, & Clifton, 2006).
Tappan (1997) asserts that “an interpreter understands by constant reference to her own
perspective, which shapes her understanding of the world based on her expectations,
preconceptions, biases, and assumptions that rest fundamentally on her lifestyle, life
experiences, culture, and tradition.
Thus, IPA is collaborative research approach that requires the researcher to share
meanings and understandings with one’s participants toward generating an “insider’s
perspective” (Larkin, Watts, & Clifton, 2006).
Interview Procedure
The interview procedure began by restating and answering participants questions related
to the purpose and goals for the study. Afterwards empathic listening and paraphrasing
were employed by the interviewer to help participants feel safe and comfortable in
sharing intimate stories of how trauma and experiences of a traumatic nature associate
with the development of a gambling problem.
While the interview process was unstructured, the interviewer probed and prompted his
participants to sit inside their experiences of gambling and trauma (Solowoniuk &
Nixon, 2009).
This appeared to help amplify interpretations of experiencing and together the
interviewer and interviewee expanded their understanding of how trauma affects
personhood and how this then influenced the origin, progression, and complete loss of
control of one’s gambling behaviours.
Theme Construction
Theme construction involved five processes (van Kaam, 1966; Solowoniuk, 2009).
Hypothetical grouping
Condensation
Elimination
Reconstructing
Final deconstruction
Terms and Terminology
Using Object-Relations theory to define the Ego, the authors refer to theorist
Frank Summers (2002), who states that ego is, “the part of the psyche charged
with the responsibility of mastering competing pressures while maintaining the
functional capacity of our organism” (p. 235). Object-relations theory states that
human beings experience essentially two births; a physical and a psychological
(Almaas, 1988; Mahler, Pine, & Bergman, 1975).
The implication here is that there is no inherent, separate sense of self from birth,
it is constructed through, in part, by our early experiences with our caregivers;
fashioning a blue print for relationships later on in life.
Thus, if a child does not have a nurturing environment that is essentially, “good
enough,” the ego does not develop normally; and in turn psychological pathology
can result (Summers, 2002). The latter point here is important to keep in mind as
all of our participants grew up in conditions that seem to have impinged ego
development through early childhood trauma.
Interpretative Analysis
Theme 1: Early Life Trauma and the Not Good Enough Self
Effect of trauma in earlychildhood created a visceral state of being.
Predominated by feeling of anxiousness, loneliness and emptiness, or “loss of
being”.
The developing sense of self (ego) appeared to be bitterly cut off from its own
ground of being (Almaas, 1988, 1997).
Dampening of affect.
Lizzy Stated:
I started hanging out with older guys in the pool hall, and kind of wanting attention all the time
and my Dad had a real reaction to that. He thought I should be a good girl, instead of a bad
girl… So I guess that’s why he only beat me... Only me... And then their was, well my Mom
and Dad didn’t like each other either... My mom was a nasty drunk... I always looked for a time
when they were happy together, you kind of seek that, I mean when you know your parents have
some kind of harmony or connection. I mean what other reference point do you have when
you’re a kid.
Mirroring from parents is natural, but not receiving it was a
predominant experience shared by our participants (we then seek is
elsewhere).
By the age of 12, Lizzy tried to pacify herself through substance
use and years later by binge gambling.
Matty speaks about: Emptiness
I don’t think it ever goes away honestly, to tell you the truth. The emptiness. It’s like,
you’re dying – it’s like a continuation of that over and over and over again… Because
you’re on that train and you’re going so fast that if you jump you’re gonna die anyway.
Well, you don’t really want to die. You just want those parts of your life to stop. It’s
like somebody standing there with the light flickering on and off. So what do you do?
You end up going to a corner; you learn how to block it out, right?
Corner and space is >>> Gaming Venue.
It appeared that emptiness could be blocked out or denied, but not forever.
Emptiness was altered somewhat effectively by moments of psychic inflation
(charge of energy) that fills up the holes in one’s being via a win and admiration
during gambling.
Theme 2:
Not So Innocent Beginning’s
The experience of trauma – whether in childhood or later in life – for all of the
participants seems to have left them in-the-world already searching for something to
soothe trauma’s numbing effects on the psyche/self.
Left raw and empty from past trauma, it may interpreted that all participants were
already primed for an addiction.
Thus, no matter how innocent the beginnings may seem, it appeared that our participants
compulsions lay dormant.
Some participants experienced addictions and behavioural compulsions
years before the development of pathological gambling.
Eve’s First Time in
…I got introduced to Vegas. And of course my interest was not in Vegas, because my brother
had a time share thing there. It was pure innocence because his son couldn’t make it – oh yeah
I’ll join you! Well that was my first exposure. When I got there it was like, glitz! And I
thought, is this me? I’m looking around, sweating it out there. Looking at the strip. And of
course you throw in a few coins and of course, ding, ding, ding and outcome the quarters...I
enjoyed it, I had fun…nothing happened, it was okay.
Sum of Not So Innocent Beginning’s
Beginner’s luck, winning and enticement
Downplaying “effect of affect”
Begin to learn how gambling can be an escape
Seduction & Intoxication
Theme 3: Seduction and Intoxication
“The high or rush associated with the game and the gambler is well documented across all
cultures throughout history. Lady Luck with her spinning wheel of fortune beckons (Currie,
2007, p. 17).”
Seduction Summation
Seductive nature of gambling and its phenomenal affects both sooth (sense of emptiness)
while heightening gambling experience(s).
For some participants accumulation of stressors added to the drive to gamble more.
There is a progression financially and psychologically.
I found something that “feels right”.... “I feel right”
Theme 4: Opening the Doorway to Oblivion
Oblivion - “A state of forgetting”?
Oblivious Accounts
Liz reported... “It’s all about changing the way you feel, it’s all about not wanting to deal
with things that are painful. I think to me, that has been my experience.”
Matty remarked... “Pawning… I lost every single one of my rings. It wasn’t 24 hours but
I mean, I’d go to work right? I mean, as soon as we got paid we wouldn’t even go home
after. It got to the point where we just went straight from work to the bank to the bar and
yeah [Laughter]. And I would be dipping into the rum and coke and he’d be drinking his
beer. And then we’d be like, okay! And at that point in time, too, you gotta remember,
those vlts – ummm – you had to wait for them. Because everybody would be on them at
that time. So we’d be bouncing all over the place. It was almost like a panic if we didn’t
get on a machine”.
Barb reiterates... “I started going for an hour after work, and then it got, then I couldn’t
get the work done fast enough to get back to the casino to gamble. I played for twelve
hours straight. Because by this time I had let bills go, and I was kind of trying to gain the
money, I hid the bills as they came in and when [my husband] wasn’t around, and then
he started ignoring me. [Feelings]?... Well, I didn’t care. I just wanted to get back to the
machines. It was like easy money”.
A Sanctuarious Space
Fecundity of the case (Gadmer, 1975)
Arising from Oblivion....
We are not talking about the classic escape gambler!
We are talking about direct impingement upon the psyche from a
traumatic or traumatic events.
Sanctuarious narratives...
It seemed the less absorbed you were with it [grieving], that your generally up winning, I
can’t remember trying to win. It always just seemed like it was a place I could go and
hide from the world, and I didn’t have to do anything or talk to anybody.... It was a
space for me to just be... (Kathy).
Kathy was able to contain psychic energies within herself and the pain she
was feeling...
A return to the wellspring of Being?
I could comprehend more and feel more of what was happening and accept that fact that
my husband wasn’t there and he wasn’t coming back [Alzheimer’s disease] and he
wasn’t getting better and people kept on telling me you have to go on with your life and
you have to stay healthy for him, and it just automatically starts to heal. I don’t know
what the hell I would have done to fill those hours; I don’t know if I would have gotten
really mentally ill.
Theme 5: Trauma and Ties that Bind Us
Exposure to trauma and its effects are unique to each individual and its repercussions can
be felt in all areas of life, i.e. (emotionally, mentally, physically, socially, and spiritually)
(Levine, 2005).
Trauma arising from childhood and adulthood (especially within families) echoed from
the past thru to our participants relationships in the present.
When support was needed during gambling addiction - their was a difficulty in our
participants asking for help or in trusting oneself or others.
Frozen in time - both the body of trauma and the (personal) relationships that are
connected to them (Levine, 2005).
Trauma Bonds and Unfinished Business
Martha provides an illumination of this phenomenon: “When I...do win, especially
big...and people are coming to me, trying to borrow and all that...I felt big. And I
thought, well at least I’m somebody today because I’ve got money.”
Chase ideals, both socially via relationship and financially; both of which
are not born from our own being.
Matty sadly remarked: …Through the abuse that I’ve gone through, I would say that
yeah, I have a very addictive personality. I can cling onto things pretty quick…and…
the really good people that I run into, I throw them as far away as I possibly can; because
I’m going to end up being the one hurting them. They’re not going to hurt me or maybe
I subconsciously think that they will hurt me; because their lives are too perfect – and
I’m kinda not in that category of perfect.
Resurfacing
I went to my pastor and we went through six sessions with him, and he told me that the
only way that I would get that out of my system [sexual abuse] is to forgive. You know it
went on for five years. I’d try to block it out and then it would come back, I would block
it out and it would come back. Then a lot of times when my Dad was still alive him and
my Mom would come to visit it just about drove me drinking…And I hated my Dad, but
I mean I done it for my mom. My mother is still in denial that my father abused me and
my sister and we just put that behind us (Barb).
Traumatic memories or associations appeared to resurface for our
participants
And once gambling becomes a learned panacea... It makes is easy
to want to regulate feelings of not being okay
Resurfacing coincided with relaspe(s) and gambling binges
Barb concludes Ties that Bind Us, stating:
“Well I hated him and I think it was there for a long,
long time and I had to get away from that hate.
Because it was a bad feeling. And it wasn’t right to
hate my dad. It wasn’t right for me.”
Theme 6: What Trauma Does: Introspection into Access
Participants report that trauma freezes their capacity to “feel” and it appeared that it also
arrested ego development
Creates feelings of inadequacy
Overt need for mirroring
Push into the unconscious (I acknowledge / I don’t )
Shame bonding
Trauma and gambling become intertwined
Trauma and its link to Gambling
Deep down I think I do [equate early childhood losses to gambling]; because they didn’t
see me go through all my tribulations and the graduation, all the highlights that would
have been in my life. Yeah, they died too young [parents]. In a way, even though they
were really strict and that, you still have a loss of being… And then something triggers it
[her gambling]…I kind of try to figure it out myself, too, because I’ve gone to a
psychologist. I’ve gone to the mental health – they said, geez, you seem to be pretty
even-keeled. You’re outgoing, you’re this and that. But I said, but there’s something
underlying it. You know, there’s something deeper. And I haven’t got to that deep part
(Eve).
For participants, first their was trauma and then gambling acted, “Like a camouflage. It
wasn’t really...an answer. Yeah, it wasn’t an answer but yet I still went to it. Because it
didn’t talk back. It was one on one.”
But Eve’s mind would come back to gambling again and again trying to find one.
Such a phenomena was first delineated by Freud (1938) - the classic
corrective emotional experience.
Gambling, Trauma, and the Need To Be Seen.
Wounding in childhood or wounds in adulthood compounded the feeling of “not okayness”.
Hence, as stated previous, participants reported feeling not good enough, frozen, and
emotionally cut-off, it is no wonder then that winning and receiving admiration fuels a
continued desire to play.
My other part of our life was rejected, because I couldn’t, I didn’t feel like a wife
anymore it was. When you win at the machine and everybody comes around and
you are very special and everybody’s looking at you and saying hey, you won!
Good for you!
Theme 7: Gambling Becomes Trauma
The gambler becomes like Sisyphus rolling the boulder up the hill... (were our participants
happy playing again and again).
Jungian analyst and author Linda Schierese Leonard (1989) parallels mythic literature and
provokes a deep question about the experience of addiction:
Is addiction, then, the act of giving oneself over to something as one’s master – be it
a substance, object, person, or activity – so totally that one’s entire being becomes
possessed by it?
Conclusions: Trauma and Gambling
Trauma in early childhood impinges ego development
Creating deep rooted feeling of “not good enough” (visceral)
Creates hunger and drive need to be seen
Cuts us off from essence / vitality (emotional body)
Prone to periods of emptiness throughout life
Trauma lies in wait
Recovery From Trauma
According to Herman (1997) recovery from traumatic events unfold in three :
Establishing Safety
Remembrance and mourning
Reconnection with ordinary life
SAFETY
Establish Safety (regain control)
Feeling safe in relation to others
Support
Letting go of addictive behaviours
Name the demon
Make connection with abuse and symptoms and behaviours
Trusting Therapeutic Relationship
Remembrance and Mourning
Tell the whole story
Repeat until story is part of survivor’s experience rather than focus
Memory coherent linked to feeling
Grief and other symptoms retract / less intrusive
Reconnection
Create new self / new future
“I know have myself” - basic trust
New relationship or old re-established
Understands damage becomes person she / he wants to be
Imagine, fantasy, desire, and initiative