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The brain’s cue and reward system

What are cues, and cue avoidance?

Cues and cue avoidance vary depending on the individual and their specific gambling triggers. A good way to identify your cues is to spend two-to-four weeks noting down all your gambling activities, including the date, time, wager and what was happening. This could be either just before placing a bet, or before the desire to place a bet kicks in. After several weeks, patterns will emerge – these are likely to be your gambling cues.

For instance, if you gamble at 5pm every day, time is your cue. So, to avoid gambling, you have to be engaged in doing something else at that time of day. What if you drive past a certain pub, and can’t help but turn into the parking lot? Then seeing the pub is your gambling cue and you should find a new route to avoid it.

Cue avoidance is powerful, but it doesn’t address the underlying cause. Even after months of avoiding a cue, it is possible to relapse if the cue is triggered. This method alone requires a lot of willpower and self-control, but it can be done.

Are all methods of changing how you think generally effective, or is one therapy more effective than another?

A good rule of thumb is that more is always better when it comes to therapeutic treatments.

People can respond differently to different therapies. Whereas cue avoidance is right for some, cognitive behavioural therapy might be right for others. So, combined therapy may simply increase the chances of an individual finding the right treatment for them.

The brain likes to save energy, so think of the brain as a prediction machine. Right now, you are not actually reading these words – your brain is using your past reading experiences to predict what these words should be, and so long as these words are close enough to your prediction, you experience the prediction rather than reality. It's a strategy: think of how hard it was to learn how to read. Now you can do it effortlessly because the brain built a pattern and runs on autopilot.

This is what happens with reward switching. After a cue leads to a specific behaviour enough times, the brain recognises the pattern and just brings the reward up in the chain. It assumes, ‘cue A always leads to behaviour B, which always leads to outcome C. So, let's skip the middleman and just bring outcome C out when we see cue A’.

It's like Pavlov's dog. Combine a bell with food enough times, and the brain will build a prediction that leads to salivation at the sound of a bell. This will help it save time and energy from processing things later.

It can be a flawed system, but it’s very powerful most of the time.

This happens with gambling too. For example, walking past a pub may create a dopamine hit that causes an urge to gamble, because the brain has associated the pub (the cue) with the high from gambling (the reward). The person feels an urge to gamble in order to fulfill this reward chain, even if they didn’t feel like gambling before they walked past the pub.

Why do changes in the brain cause some people to become addicted to gambling, but not others?

The brain changes due to thoughts and actions. When two people undertake the same action, it's the thought which may lead to addiction in one person, but not another.

For instance, if we both parachute out of an airplane, you might think, 'fun!' while I'll be thinking, 'terror!'  It's ultimately this thought which will drive the final brain change and outcome – leading you to want to parachute again and me to want to go home and cry.

It’s the same thing with gambling. Some people do it and think, ‘fun!’ – this supports the behaviour and can drive addictive behaviour. Others think, 'not fun' and no amount of repetition will change this.

Why is it that even when the reward leads to very negative consequences, the brain still anticipates a positive experience?

When the reward moves to anticipation, it is no longer about the experience being positive or negative. A craving is simply something that must be satiated. If you're crossing the desert, then any water is good water – not because you were looking for a rewarding experience; you were just trying to quench your thirst at all costs. This is the gambling quandary. When a reward becomes an urge, there is no longer any reward involved – there is simply relief – and that relief will come regardless. Any way to scratch an itch is better than the itch.

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