Chapter 14

“Gambling is killing me! What else you got?”

One morning I walked into our large fourth floor day room in Reno to begin group therapy and found a crowd at the open windows. There were supposed to be only six people in the group, but all our patients and most of the staff were there.

“The balloons are going up any minute, Dr. Taber,” offered a resident named Edgar, taking his eyes off the sky for just a moment.

Edgar was always sensitive to his social situation. Some people have keen situational awareness, others do not. A cheerful extrovert, Edgar was a problem gambler who had given up everything a few years before to move to Reno, where he could spend all his money on gambling without having to pay for bus tickets from California. That plan had led to sleeping at the Salvation Army, alcohol abuse, and finally, hospitalization on our Addictive Disorders Treatment Program.

We got many Edgars in Reno, people with mixed addictions, personality problems, and shattered dreams.

The annual Reno balloon race attracted a sky full of beautiful airships. Their owners came from all over the country and usually enjoyed perfect weather for the event. This day was a brilliant, blue-sky example.

What was a psychologist to do? Should I pull down the blinds and force everybody to go through the motions of group therapy when they knew they would be missing an incredible show?

I had no intention of missing the spectacle myself, but here was a chance to play the magnanimous, kindly father figure. I had learned in the military and in the federal bureaucracy that a good leader notes the direction in which the troops have already decided to march, then runs out ahead of them crying, “Follow me!”

“Hey, people,” I said, “the taxpayers want more from us than watching pretty balloons.”

“Screw the taxpayers,” muttered an elderly fellow named Ralph. “The balloons only happen once a year. Besides, look down there at the picnic tables. All the bosses are out there watching, too.”

Edgar wasn’t the only sharp-eyed, socially aware person in the room.

“All right, people,” I said, “let’s get into our circle of chairs and get started with the group. When we spot the first balloon we’ll all go outside and watch. Will that work?”

The others left, and my little assembly quickly fell into the familiar, sweet-and-sour pattern of group therapy. I usually tolerated no interruption to group sessions unless some emergency came up, and I was taking a risk that someone might be in the middle of a sensitive and revealing statement when up would go the cry, “Thar she blows!”

I opened the session with a fishing expedition, a rambling comment, knowing there was a group problem needing attention. There was a story that needed to be told.

“I’ve often heard people tell gamblers and alcoholics to find a substitute for gambling or drinking. Substitution seems like such an easy, sensible alternative. Why not just substitute X for your gambling as a way of using all that extra energy and time?

“People suggest all kinds of activities, and gamblers have tried many alternatives. Substitutes for an addiction include having children, getting into religion, trying a new kind of work, playing a sport, getting active in politics, and even getting more sex.”

“Last one sounds really good to me,” muttered old Ralph, the fellow who wanted to screw the taxpayers.

“It’s never too late, I guess,” I told him.

“Yeah, look out, Ralph,” said Edgar. “Remember that guy with the two-toned shoes who got discharged Friday? He was a sex fiend and an alcoholic. Dr. Taber asked him to count the number of different women he’d slept with in his life. He was an old guy with lots of hash marks on his sleeve. He claimed about 1,700 women for a lifetime score. Now that’s an addiction.”

“I don’t think Ralph’s that ambitious,” I said. “But over the years I’ve seen alcoholism patients leave programs telling me they were going to develop what they called hobbies to replace alcohol. I used to smile and approve uncritically. Then I asked an alcoholic what hobby he was planning to take up. He said he was going to be picking winning horses; he thought he might have a knack for what he called the business of racetrack gambling. That bothered me, and I started asking the question more often.

“Sometimes the alcoholic tells me he plans to play more cards with friends. Card playing for small stakes is a popular social growth experience or recreation for recovering alcoholics. Bingo in another popular recreation because it’s fun and is supposed to let you enjoy an evening with the wife or family. This all sounds good to some people.”

Silver Feather, a Native American from a nearby reservation, raised his hand. I’d tried to explain to him that in the group anyone could speak without raising a hand, but he would not change. Since he was generally silent, I had decided to leave the issue alone. He could speak on his own terms, and that was fine with the rest of us.

“For the Indian,” Silver Feather intoned, “the only substitute for alcohol is a sober life. For the white man there’s no substitute for his gambling.”

“Well, guys, Silver Feather has spoken, we can all go home now,” growled Nikko. Nikko was a range rat, an old ranch hand of Basque ancestry who had spent all his life alone or with other hands, tending the herd, mending fences, and getting drunk at payday card games. Nikko had never seen a physician until he came in for detoxification and treatment of an infection. The medical unit saved his life and then passed him on to us for alcoholism treatment. Nikko did not like Native Americans. He had been angry when he told he could not keep his revolver with him in the hospital.

“Silver Feather is a practical kind of guy, he gets to the point quickly,” I said, ignoring for the moment the smoldering feud between Silver Feather and Nikko.  “You have to admit it sounds logical for the alcoholic or drug abuser to pick a sociable pastime like gambling to help get by the first months of abstinence. Sam, you’ve been quiet so far. You’re here with a gambling problem. The group knows that. What will you do with your time and energy if you don’t have gambling to keep you busy every day?”

I had cast the bait. All eyes went to Sam. The group knew where I was going. They knew that Sam was feeling angry and left out, that he had not really shared his full story with us.

“I came here because of you, Dr. Taber. You have a reputation as a specialist in treating gambling, so I was surprised to see you have a mixed group here. I thought I’d be with other gamblers, people who could really understand me. I’ve complained to you and even to the Chief of Staff about having to live with alcoholics and druggies. I’m not one of them. I’m a gambler.”

“You don’t like the company, get out of the game,” snarled Irv, the casino dealer, a man whose love of cocaine had ended many good jobs. It was a love affair he could not afford, and that his body could no longer tolerate. For Irv, it was time to quit or die.

“Of the six of you here,” I said, “there is, as Sam says, quite a mix. Sam says he’s just a gambler. How many of the rest of you have a gambling problem beside whatever else brought you in here?”

Three hands were up. Sam, Ralph, and Silver Feather kept their hands down.

“Naw, not me,” said Ralph. “I never gambled. I’m just a drunk.”

“OK, Sam,” I continued. “Three out of five substance abusers here admit to some kind of problem with gambling. Do you have any problems besides gambling?”

“See,” Sam said angrily, “that’s what I mean. Nobody here understands a real compulsive gambler. I have to go to those damn lectures on alcohol and drugs. I have to look at those damn films on every addiction in the world. Doesn’t anybody understand that a gambler is special and different?”

Silver Feather’s wrinkled, brown hand was in the air. “Addiction is addiction,” was his slow, deliberate response.

“What the hell is that supposed to mean?” demanded Sam.

“It means,” piped in Nikko, “that since addictions are so similar to each other, gamblers could learn a lot about gambling by looking at alcoholism.”

Silver Feather and Nikko stared at each other in surprise, realizing that they had agreed on something at last. I caught just a trace of a smile on Silver Feather’s lips. The night nurse would tell me the next morning that Nikko and “The Quiet One,” as Silver Feather was called by the men, had stayed up past midnight talking to each other.

“Alcoholism is a physical thing,” said Sam, “but gambling is a pure mental addiction. I have to sit here and be exposed to the ramblings of these sick degenerates. I have nothing in common with them, Dr. Taber. I’d tell any gambler in Gamblers Anonymous to avoid alcoholics and drug people. They only depress me, and I’m depressed enough already. Alcoholics may spend a little too much at the tables when they’re drunk, but that doesn’t say they have a real gambling problem. Hell, no alcoholic can really understand a compulsive gambler. They’re only detracting from my own recovery.”

Edgar spoke up. “Sam, you and I both know that Gamblers Anonymous was started by a pair of recovering alcoholics who couldn’t control their gambling. They just applied the AA program to gambling, with a few changes.”

Sam knew that, but his problem was about his self-image, not about ignorance of GA.

“Sam,” I started, “our physician put you on an 1,800 calorie diet to help cut your weight, and you immediately started to complain that you were being denied enough food. You said yourself you’re about 50 pounds over your best weight, and that you have difficulty breathing when you get emotionally worked up. You might want to consider looking in at an Overeater Anonymous meeting someday to see if that would help.”

Sam was set to explode. “Now you want to stick me with a bunch of fat old whores!”

Ignoring his blatantly unfair characterization of Overeaters Anonymous, I plunged ahead, laying out some facts of which he was well aware. He would get his chance to respond.

“You wanted to be given a tranquilizer, Valium, I think. You said so during group here last week, and the men all told you that Valium could be very addictive. You saw the alcoholics in detoxification getting Librium to ease their withdrawal from alcohol, and you told us you needed something yourself to calm your nerves, because you felt you were going through withdrawal from gambling. You said that was too hard to do without some chemical help. You used the word withdrawing yourself. When we told you that Valium could be addictive to certain people, you argued that you’re an exception and that you could never get to the point of depending on drugs.”

Sam’s right hand moved to his left shirt pocket where it caressed his package of cigarettes. He wanted a smoke now, and the group picked up on that immediately.

Ralph slouched to the side of his chair in Sam’s direction, chin in hand, and told Sam, “Hey, guy, you’re a heavy smoker just like the rest of us addicts, and you resent the fact that they don’t allow smoking during group therapy sessions, don’t you?”

“Just a gambler, eh?” said Nikko, grinning.

Sam couldn’t stay out of it now. “How,” he demanded, “is anyone supposed to take part in a stressful thing like group therapy without smoking? Besides, smoking is not an addiction. I could quit …”

Whatever else he wanted to add was drowned out by laughter from the group.

“I’ve explained to you, Sam, that scientific studies show smoking causes more problems than it solves,” I argued. “It doesn’t fix anything, and it’s as dangerous to health as any other addiction. Tobacco is just one more addiction that happens to be legal.”

“Well, Doc,” Sam answered, “at least gambling isn’t physical, it doesn’t wreck your liver or your brain or your lungs.”

“Thirty percent of gamblers coming into treatment have serious heart and circulatory problems,” I told him. “Heavy gambling causes physical and mental problems just like alcohol or drugs. The kinds of problems are different, but as Silver Feather says, addiction is addiction. With your weight, your smoking, and your gambling stress, I wouldn’t write you a life insurance policy.”

“Damn,” growled Sam. “We’re not getting anywhere with my gambling problem. I should just get the hell out of here.”

“I don’t think that’s what your wife has in mind, Sam,” I said. Now he was looking at me with a mixture of surprise and concern.

I continued. “You remember the other day in group, when you said it would be OK if I called your wife to get her side of the story? She was the one who begged you to come into treatment, and maybe she should be getting some kind of help herself. I spoke with her yesterday afternoon on the phone for quite a while.”

“I hope you straightened her out,” said Sam. At that the group laughed heartily again.

“She has one thing straight,” I said. “You’re not going back to live with her if you don’t finish your treatment.”

“Let’s talk about this in your office.” Sam was desperate to avoid getting to the real issues that threatened his life.

“Everybody knows we just don’t have time for individual counseling here. Besides, we believe groups work best to teach honesty and caring for others. You agreed when you came into the program that all problems here are group problems.”

“Did you tell my wife about all your chicken-shit restrictions and rules?” asked Sam.

“The fact is,” I said, “before I could call her, she called me. You weren’t on the unit when she called so you weren’t available to be with me during the conversation. But I hope you remember, you signed a consent order allowing me to talk with her, so I took the call alone.

“I asked her to tell me in her own words just what she thought your problems are, and she didn’t waste any time ticking off her list. If you don’t want me to discuss what she said you have the right to stop me. But you’ll have to leave the program. It’s up to you. If you stay, all problems are group problems. That’s our program philosophy. Sobriety is the No. 1 priority, along with honesty and responsibility.”

Sam was silent, staring at the floor.

Silver Feather had his hand up. What now? “Yes, Silver Feather.”

He was gazing past me into the far distance, and I waited for him to unleash more wisdom. Then I saw that he was not asking for recognition; he was pointing straight up and at the windows with his index finger.

As one, we turned to the windows on the north side of the room. Then everybody was on their feet heading for the door. Edgar was the first out of the room, going down the hall as quickly as he could, shouting, “The balloons are up! The balloons are up!” Silver Feather followed at a slow pace, moving with the dignity of a great chief.

As the group disappeared down the stairs, not waiting for the elevators, I walked slowly down the hall with Sam. “Nobody said treatment was easy,” I said softly.

After a long pause, he said, “It scares the hell out of me, Doc. I know what Liz told you. I’m not stupid. I just don’t know how to turn any of it around, especially not all at once.”

“If you start now, Sam, you’ve got the rest of your life to work on things, one problem at a time, one day at a time. If you can’t face facts in the group, if you run, I don’t think you have very many days left to work on anything. It looks impossible to you now, I know, but a little faith, a little willingness, will go a long way. It won’t be easy, but the only way to deal with your fear is to start talking about the tough stuff.”

Outside, we stood in the grass in the sun and craned our necks in awe of the incredible sight, dozens of colorful hot air balloons gently floating above. They filled the sky, the roar of their heaters faintly audible. Some were striped, some patchwork-patterned, some multi-colored. A huge Mickey Mouse was followed by a balloon motorcycle, then a giant can of soda. The people in the baskets suspended below the balloons were staring back at the people on the ground, and there was much waving and pointing.

Edgar bounced around, unable to restrain his excitement. Silver Feather shaded his eyes with a hand and gazed impassively aloft. When I glanced at Sam I saw that he was tearful, but he was transfixed and moved by the parade of balloons.

After half an hour the balloons began to drift off in the distance, and we slowly drifted back to our own version of reality.

Back again in our circle of chairs, I began with a question. “Do you fellows care enough about Sam to listen to what his wife thinks about his problems?”

The general feeling, as I knew it would be, was indignation. There was a general murmur of agreement; “Of course we care about Sam.”

Silver Feather raised his hand again. “We’re family here. All problems are group problems, just like in the tribes of old.”

“Sam,” I said, “the guys care about you, and so do I. Keep that in mind, ‘cause some of this will be hard to hear.

“Liz told me that her first priority was your drinking. You get drunk on weekends, you miss work, and you’ve beaten her during your drunken rages.”

No one in the group seemed at all surprised by this information. Sam stared at the floor.

After a long silence, I continued. “So, guys, we have a foodaholic, nicotine-dependent alcoholic, who denies his alcoholism and is holding out to be treated only for gambling.”

Another pause. The group seemed relaxed. Six pairs of eyes were on Sam, who said nothing.

“Liz’s second priority,” I continued, “was not getting beaten up and yelled at any more. Alcohol helps get you going sometimes, but it doesn’t seem to be necessary to get you started abusing her. She asked if I could please help you learn to control your temper. She thinks you’re addicted to violence. For a few men it does seem that fighting, arguing, and getting violent produces some kind of exciting high. Or, maybe, if you provoke an argument, it gives you an excuse to go out and gamble or drink. If a person is very depressed—and I think most of our residents are when they first come in—fighting is one way to fire up your spirits and chase away the depression.”

“Bullshit,” muttered Sam, without looking up.

“Are you saying that you don’t have a bad temper, or that you don’t believe my theory of depression?” I asked.

There was no answer.

“We have a man addicted to food, nicotine, alcohol, and violence, who only wants to look at his gambling problem,” I said. “But it gets worse. Hang in there, Sam, you’re doing fine.

“Liz told me she had a third request. She wants you to learn to live without stealing your father’s tranquilizers. She says you’ve been doing this for years now. When you mix alcohol and tranquilizers you run the risk of serious brain damage. Here in the hospital you’re trying to convince us, and maybe yourself as well, that you’re withdrawing from gambling, when you’re probably experiencing some withdrawal from both alcohol and Valium. You weren’t honest with us when you did your admission interviews, Sam.”

Again, I summarized the list of horrors, as gently as possible. “So we have a man claiming to be a problem gambler who abuses, misuses, or is psychologically dependent on food, nicotine, alcohol, violence, and Valium.”

Sam was suddenly up on his feet, and none of us could be sure what he was about to do. Looking at no one, he spun around and went to an open window.

The screens won’t stop him if he intends to jump, I thought, but before I could move, Edgar and Nikko were at his side. Irv, Ralph and I stood ready to act quickly if we had to. If Sam needed a break, some time to think, we would give it to him, of course. But he would not be allowed to be alone at this point.

But Sam was looking up at the sky, not down to the ground. I knew that the beauty of the balloons had moved him. Perhaps he hoped they would come back, perhaps he was dreaming that by some magic he could escape the misery he had made of his life, and just float off to a dreamland where he could enjoy all his pleasures with no bad consequences.

We all understood that Sam was at some kind of turning point.

Edgar retreated to his chair. Nikko, the tough old range rat, the man who had spent most of his life with cattle, put an arm around Sam’s shoulders, squeezed his arm and said nothing. After a bit Sam came back to the circle. Both men now had an arm around the other’s shoulder.

Men are often accused of suppressing their feelings, of being unable to put them into words. It is true that when men are very emotional they often don’t talk about their feelings with words. That doesn’t mean they don’t understand one another, or recognize each other’s feelings, or fail to communicate. Men communicate very well among themselves through expression, gesture, and body language. Group therapy with women is very different from group therapy with men, and mixed groups are doubly challenging and rewarding.

One by one, each of the men went over to put a hand on Sam’s shoulder or squeeze his arm. A calmer mood had come over the group. Sam now sat with his head down, hand over his eyes.

“What’s in your thoughts now, Sam?” I asked.

“I don’t say she lies. She’s a good woman. She deserves better. That’s for sure. She’s not my problem, but she wants a lot in a hurry. I just can’t deal with everything at once. You expect me to be perfect, and I can’t fix it all at once.”

“We ask for honesty, not perfection,” I answered. “Change can only begin if it’s based on complete honesty. No one can make you stop smoking, drinking, or overeating. That’s not what we’re here to do. Our job is more difficult, and so is yours. We’re here to help you start to grow up, to help you learn what adult responsibility is about, and to help you see that you do have the strength to face your problems.”

Sam seemed calm now, and I hoped he was ready to start serious work toward personal change and growth. “It’s going to be lunch time in a few minutes, group,” I said, “and I can finish quickly if Sam will put up with me just a bit longer.”

“Give it your best shot, Doc,” said Sam.

“Liz’s fourth priority is the gambling, so at last we get back to where we started. The gambling has kept you poor for years, and prevented your son from getting the expensive special education he needs. Her fourth priority was the gambling, the only problem you’ve admitted to so far, Sam.”

The group was saturated for the day, so I wrapped it up with one final summary, and an assignment.

“It would have been better if we could have waited for Sam to tell us about all the things that are causing pain in his life. But he’s only here for four weeks, and the administration wants us to cut the hospital stay down to two. So we push you guys pretty hard.

“OK. We have a pathological gambler wanting help with his gambling, but he’s a whole lot more. You’re not so special, Sam; it’s always a whole lot more, in every case. Each case is a complex one, fellows. There are no simple gambling, alcohol, or drug problems. And there is no simple cookbook plan for fixing any of it, but there is a way of working and growing. I hope you understand, Sam, that if we ignore your other addictions we’d be acting as irresponsibly as any addict. We need information and facts before we can begin to make judgments. That’s why honesty is so vital.

“We don’t really have the power to make Sam admit to all his dependencies, but I know he has the intelligence to listen. If Sam just stopped gambling and ignored his eating, smoking, drinking, and temper problems, what kind of abstinence would that be? How long do you think he could abstain from gambling with those fires still burning in his head? Do any of you think for a moment that Sam could build a better life if he only stopped gambling?”

“Are all pathological gamblers addicted to so many different things?” asked Irv, the dealer. “I see them on the casino floor smoking and drinking and trying to pick up women. Many of them are fat, too.”

“No! Definitely not,” I said. “They’re prone, just like alcoholics, to multiple addictions. And they are very prone to substitute another addiction for gambling when they quit. But please do not leave here thinking that all problem gamblers are in as much trouble with appetite as Sam. Remember, our program is the end of the road for many people who have used up their other resources. We don’t get the easy or the typical cases here, so we can’t judge all gamblers by the folks we see here. You guys are the cream of the crop.

“For tomorrow’s group I want each of you to write a paragraph that lists those things that you, yourself, might be in danger of using as substitute addictions, if you did abstain from your primary addiction. If anyone has trouble with spelling or writing, please remember that you can ask any member of the group to help you. All problems are group problems, even spelling.”

As the men shuffled off to lunch, they passed words of encouragement to Sam. I knew they would be talking now on their own, and that their conversations would be about recovery from addiction, not about sports, women, or the weather. People who go through therapy together often stay in contact with each other for years. They can become, as Silver Feather had said, family, and it can happen in only a few weeks. Shared honesty has that effect.

Late that afternoon, in our brief staff meeting held at the close of each day’s work, I talked about Sam and his problems. Some counselors on the staff focused on one addiction at a time, rather like Sam. All of them had been working with the traditional substance abuse disorders like alcoholism much longer than with some newly recognized addictions such as tobacco, food, and gambling. I had worked hard to get the staff to understand gambling addiction and to accept it as something worth treating. And we had just added a Stop Smoking Clinic to the program. The dietitians were also doing their best to teach better eating habits to the men.

My appointment as chief of the Addictive Disorders Treatment Program did not come without some unhappiness by certain staff members. Some would have preferred a medical doctor as chief, others a recovering person. My relationship with the addictions treatment team was still a work in progress, and our meetings still had an uneasy quality.

A few of the staff sitting in front of me, I thought, were sad examples of incomplete recovery from addiction. Others were professionals who never had problems with addiction, and who seemed to lack the concern and empathy I thought was necessary for productive work in the field. Nevertheless, they were all good people and were trying, in their turn, to get used to me.

Some of the staff looking back at me, I knew, were wondering what this strange Piled Higher and Deeper (Ph.D.) was going to come up with today. Change is as hard for staff as for patients.

I reviewed Sam’s hospital record briefly; most of the staff knew Sam, either from his complaining or from his having been in the lectures they gave to all the patients. Sam was not well liked.

Hoping to keep the discussion constructive, I began by summarizing the things I had told Sam during our morning group session. Then I continued with, “Sam is an extreme example, who illustrates how people can deny what others can see so clearly. He’s a wonderful example of substitution therapy waiting to happen.

“Most gamblers aren’t alcoholics, but about 45 percent of them have alcohol problems. In other words, alcoholism is often waiting there to take over if gambling stops, and if new personal growth doesn’t get started early in recovery. Gamblers are seldom just gamblers. Like all addiction-prone people, they really get into things. They consume life in a passionate and compulsive way. If they don’t have any peace of mind while gambling, they also don’t have any peace of mind while not gambling. That, I’m sorry to say, is because few men and women who give up gambling ever really accomplish much real personality change. Serenity is just beyond their grasp. They fail, more often than not, because of a tendency to substitute some other compulsive behavior for gambling.”

There came a challenge from the floor; “There’s really nothing about gambling itself that breeds compulsive behavior in everyone, is there? I’ve seen the same tendency to substitute addictions in alcoholics.”

“No,” I responded, “gambling is not the enemy; alcohol is not the enemy. In the hands of most people, golf, alcohol, work, and even drugs never cause problems. Most people who do use alcohol, drugs, or gambling do so responsibly, without ever becoming addicted. Sometimes, working in the addictions treatment field, we forget that fact. But in the hands of a person once addicted to X, any Y can turn into a compulsion. If we don’t help that person achieve a higher level of maturity—if we can’t help them to change attitudes, values and priorities—they will relapse, because substitute addictions will surely undermine their resolve.”

Our social worker had a comment. “Well, that’s our job, isn’t it? We’re not here to make them stop. We’re here to get them growing and learning and changing.”

“Thank you,” I said. “I hope we all understand that. We’re not prohibitionists or policemen. We’re more like parents trying to teach responsibility.”

Fred, one of our recovering counselors, had a comment. “When I first got sober and moved to Reno I did a lot of gambling, and I thought it helped me get used to sobriety. I saw where it was taking me, though, and quit. But there’s no substitute for alcohol or gambling. There’s nothing like them. What could possibly take their place? Nothing could ever give the alcoholic or the gambler the same mental lift, the same adrenaline rush. Nothing!”

“And nothing could ever cause the misery that comes later,” added the social worker.

“Nothing can replace the high, except staying clean and sober so you can work helping others to give it up,” said Horace, another counselor with a good history of recovery from drug dependence. “Helping others—working in the addictions field—can be a positive rush when you see someone making big changes.”

Then came a tart comment from the floor. “A person needs something to fill that void.”

The remark came from Millie, a recovering alcoholic who still smoked heavily, gambled often, and was hugely overweight. She was one of the people I had inherited from the previous management, but I admired the fact that she was always working her program and trying to improve. Alcoholics Anonymous was a very big part of her life.

“That’s the common theory, Millie,” I offered, “and we hear it all the time from patients. It’s as if they felt they deserved or were entitled to some kind of substitute, as a reward for giving up their addiction. These feelings of entitlement get in the way of treatment. When a person puts aside gambling, it’s like a child who’s lost a favorite toy; a part of the gambler’s life is gone forever. Of course, there will be a void; life will never be the same again. But nobody ever died of void poisoning,” I joked.

Millie sniffed and looked at her watch.

Joan, one of our nurses, pitched in with a comment. “But they have to live with that void, not try to cover it or fill it with something else. I think it’s a grief process, really. They have to grieve their loss and then go on with life. And so we have to expect some anger about being selected by fate to be a compulsive gambler.”

“That’s so true,” I said. “We need to recognize those profound feelings of loss, and then help resolve the grief process. A normal period of grieving is time-limited. Disabling grief beyond a few weeks or months serves no purpose; it’s symptomatic of a childish desire to live in the past and avoid personal growth. Extravagant, extended mourning is simply an avoidance of responsibility.

“Life may never be the same, but it can be far better. Most of us think that life as an adult is better than life as a child, but we all miss childhood sometimes, even when we’re engrossed in adult life. We forget how painful it was to learn adult skills when we were kids. Now we take them for granted, and can’t understand why it takes our own kids so long to learn what we practice almost unconsciously. In our fantasies, we sometimes even return to childhood. But if we’re the masters and not the victims of our fantasies, we don’t have to relive our childhood pains.”

“Sounds like you think alcoholics and gamblers are children,” Millie said. “That’s demeaning.”

“I think it’s fair and accurate to say that most people with addictions are immature in one way or another,” I answered, looking directly at my questioner. “Childish would not be accurate. But many of our patients act like children in big bodies, even when they’re not active with their addictions. For them, sobriety doesn’t seem comfortable. The way they think, their values, their priorities—these all suggest lingering immaturity. I often describe Las Vegas as the most creative playpen in the world. It’s a dream world for children in grown up bodies. Reno is not far behind.

“Let’s stay with the idea of substitution a bit longer. If you set out deliberately to replace gambling with some other thrilling experience, you’re like a child who’s had a tooth pulled and keeps sticking his tongue into the empty socket to explore the gap. All you do is irritate the tissues and slow down the healing.

“If a resident needs to give himself a substitute for gambling he’s probably doing this out of feelings of entitlement; he probably feels he deserves or has the right to some reward for having stopped gambling. When you think about it, it really doesn’t make much sense to reward a person for not doing something he or she never should have been doing in the first place. Feelings of entitlement are the hallmarks of the spoiled child, the child who expects a treat just for being the person he is. Abstinence has to become its own reward.”

Joan, our friendly nurse, again came to my aid. “I agree that there are no substitutes for gambling. What you’re saying is that the only alternative is personal growth. But the gambler often just goes back to the kind of work he knows, and that may even feed into gambling. So many gamblers are commission sales agents. The big commissions are like the unpredictable pattern of wins in gambling.”

“Right, they expect life to go on without major changes,” I agreed. “Working for a salary, with regular hours and close supervision seems like a nightmare. Gamblers think I’m crazy when I suggest they do some simple labor at the start of abstinence. I urge this so they can have the chance to rediscover the most basic reasons why people work. Work, for many of us, isn’t really about money, any more than gambling is about money. Work is about being of service to others, or creating some valued project, or learning new responsibilities, or the sheer joy of learning, or learning to understand that discipline is a good friend. I think that work, well done, is an act of love, a psychological peak experience. Humble work uncomplicates life and lets us see the importance of work in our lives. If you have even a simple skill, it’s the one thing that’s really yours. It’s an identity you can’t give away to anyone. You can give your money or your property away. You can’t give away your skill, even if someone else would like to take it. They have to learn just the way you did.

“If the gambler wants to continue a money-oriented, competitive job—and many recovering gamblers will, in spite of what we say—they should at least set aside a few hours every day for simple, humble labor. This could be gardening, volunteer service in a hospital, or a second job. They could even learn to do the dishes and clean the house. Wouldn’t that be a welcome change?”

“Amen!” sighed Millie who, I knew, still suffered in her marriage to an irresponsible, unemployed drinker. “When my Henry does work, he works like some kind of demon, day and night; he’s never home. But he messes up every job he takes trying to over-control things, being a perfectionist and criticizing his boss. So he gets burned out or fired, and then he tells me he can’t find work that’s good enough for him.”

Millie stopped, realizing, perhaps, that she was saying too much of a personal nature at an open staff meeting. But I was glad to hear her talking so openly about her life.

“Millie, you’ve given us a big insight into the nature of the workaholic,” I said. “Lots of recovering people try to substitute work for their addiction, and they can become workaholics even if they never were before.

“Some workaholics aren’t really compulsive personalities. They just love their work. There’s that certain joy about practicing a personal skill. The well-balanced worker, I think, can stay calm, caring, and relaxed even with long hours and exceptional demands. They seem to develop the ability to avoid too much stress. But those who love their work for its own sake don’t seem to be particularly prone to addiction, either.

“Another kind of workaholic is always rushed, angry with interruptions, intolerant of any weakness in co-workers, perfectionistic, insensitive, manipulative, aggressive, and just addicted to work. For this person—as for any addicted person—there is no peace of mind either with or without the habit. They’re always chasing and rushing. They never stop to appreciate or congratulate themselves. They don’t work for themselves. They work in the service of a compulsive, irrational addiction. The chase at work is its own reason for existence, and they pursue it in a kind of joyless, mechanical way. Of course, there’s not much time for family, they only get in the way. There’s only the insatiable urge to be working.”

“I got into physical fitness when I got sober,” offered a counselor named Jim. “It helped more than I can say. I run every day now. My physician suggested I get more active physically, and at first, I laughed at him. But he wouldn’t even talk to me about magic diets or sleeping pills. He just kept handing me pamphlets on exercise. But I recognize now that some people I know who run seem be addicted to it. They run a lot more than they need to in order to stay fit. It causes all kinds of physical problems, too.”

“Good for your physician, Jim, and good for you,” I said. “You were smart to work with him. Physical fitness should never be started impulsively. It should not, I think, involve competition. It needs to be a full and grateful surrender to a plan worked out with some experienced person. We should be telling our patients that if you’re not an expert on physical fitness, get help. Read good books on fitness and discuss your workout plans with your physician. Or pay for a few sessions at the gym with a qualified trainer. Then do it. Follow a lifetime program.

“Again, the one big caution: In the hands of a compulsive person, even a well-developed plan for physical fitness can get out of hand. There may be the temptation, for example, to try for a marathon. The old urge to compete dies slowly. If our patients remember that there is no substitute for an addiction, and that no life experience can ever deliver all that their fantasies promise, they’re safe to start with honest work, good exercise, and family living.”

“God, Taber,” sniffed Millie in a doubting, pouting voice, “all that seems dreary, dull, empty—just very boring. Is a boring a life worthwhile? Where’s the fun, where’s the freedom?”

“If you have to ask, you aren’t listening.” I was getting cross. “It’s only boring because you haven’t yet learned to appreciate the richness and complexity of mature living. Some fool probably did promise you a rose garden—a life of eternal thrills—but they lied. A child is bored by adult pastimes because he has no experience in adult living. He sees everything in simple black and white, and has no understanding of the rewards that come slowly, over longer periods of effort.

“Many gamblers are angry and depressed to think that the urge to gamble will not go away when they stop; they think that abstinence has to involve immediate freedom from the urge to gamble. But please remember that perfectly normal people often feel strong urges to do things that give intense pleasure—urges to gamble, get drunk, or spend money on luxuries. Normal people aren’t free from irrational urges. They’re just good at saying, “No!” After a while, it gets very easy, and there are no childish feelings of deprivation and resentment. But the urges don’t go away. They may seem less frequent and less intense, but you, not they, are changing. Feeling strong urges is part of being human. It also helps if you learn to curb fantasies of unlimited power and success, by the way.”

“So people have to give up sports because that’s competition?” asked Millie, reverting to an earlier topic.

“Gamblers often decide to get involved with some sport as a way of filling the void,” I replied. “Some were excellent competitors on the field and later became sports bettors as adults. Since they were stars in their high school or college sports, they expect to use their knowledge of sports to become star gamblers. Bookies love these men the way casinos love any gambler who thinks he has a system to beat the dice table. What these people have to offer the bookie is not a special skill, but a feeling of specialness; unrealistically and unconsciously, they think they are exempt from the laws of probability that apply to ordinary people. The bookie just takes his 20 percent in the spread and doesn’t care which team wins or loses.

“Let’s encourage inwardly directed physical conditioning, never competitive sports. Jog, walk, swim, cycle, or row, but don’t compete or subject others to your competitive drives. Competition is the American way, of course. But competition is just a tool, not the solution to all problems. In normal living, there is a time to compete, a time to cooperate, and a time to be alone. Early in recovery, I think, there is a great risk that competition will become the goal rather than the tool.”

“God! Could you see me trying to jog?” sniffed Millie.

“Long walks would be a good start,” said Jim, with a smile.

Horace had a comment. “When I first got off all the drugs, I got to be a meeting freak; I hung out at every Narcotics Anonymous meeting in town.”

“I did that, too, with AA,” said Fred. “Maybe it’s OK to substitute self-help meetings for alcohol or whatever. It kept me in line until I began to get life in order. Now I just stay with my home group and sometimes I get to regional or even national conventions. But we do tell the newcomers who keep slipping to get to 90 meetings in 90 days.”

I was treading on uncertain ground with my next comment. “We all know the motto of many addicts: If one pill or one drink is good, more is better. Telling people to attend 90 meetings in 90 days is rather similar thinking. What saves us, I think, is that most will do more than just attend meetings. They’ll probably pick up a sponsor and start getting involved in some kind of service work in all those meetings. So if it serves as a kind of condensed education, that’s fine.

“My impression is that such fanatic attendance seldom lasts very long. Daily attendance and frequent use of the phone list may be helpful in the first few months of recovery, and I would encourage that. Most of you would probably agree that in the end, depth and quality of participation are more important than frequency. Intense participation in a self-help group such as Gamblers Anonymous is essential, because this is the most available resource any addicted person can have for the healing power held collectively by a group of peers. The investment of the new member, however, should not be in a public show. His or her investment, with the help of a few caring older members, should be in the Twelve Steps of recovery.

“When it gets down to living out the Steps of the program, this is something each member must do alone, in their own time and pace. But members must do the steps, not just talk about them. Unfortunately, some members of GA seem to have adopted the Twelve Steps as obligations rather than as opportunities. Most members fail, it seems to me, to make even the most basic use of the Twelve Steps. The new member should try to work the Steps and accept the fellowship with humility, looking for long-term solutions, not for a quick fix.

“Here’s the last word, people: The alternative that is not a substitution is to get off all the roller coasters. Stop all the addiction games and get honest with yourself. Just try to even out the dips that addictions produce, those great swings between exhilaration and depression. Aim at building a simple life free of all the peaks and valleys. If you succeed, the whole mood and quality of life will be lifted to a level that’s difficult to imagine. Stop looking outside yourself for relaxation, pleasure, and rescue. Stop getting high! If nothing we have said has stirred resentment so far, then it’s likely this simple goal will do the trick. Right! No highs or altered states at all. Nothing to fix me! No addictive relief from the normal boredom and frustration of everyday life.

“Here the spoiled child in all of us will scream a protest and assert a right to feel good, a right never to hurt, and a right to enjoy unlimited pleasures without evil consequences.

“Inevitably, we must accept the truth. Artificial highs—those produced by addictive behavior—do not relieve depression. They cause it. They produce far more pain than they relieve. These highs give us short dreams, followed always by long, hard days under the sun of reality.

“When we stop searching for highs and accept the pains and responsibilities of daily living, there always comes a time when a very different high suddenly and unexpectedly comes over us. People often look upon it as a gift, for there is no feeling of accomplishment or control over it. It comes quietly, and it does not go away easily. It lifts our lives to unforeseen levels. It’s a high never achieved when searched for, but it’s an inevitable result of true maturation. I can give it no name. It has no existence apart from our own existence. It has no price, and it does no damage. The word serenity does not do it justice.”

There was a long moment of silence in our staff meeting now, and I realized I was preaching too much. But I had their attention and interest.

“Thanks for your time,” I said. “Let’s go home.”

Driving home along a winding mountain road, I thought again about Sam and the choice he faced: A life governed by appetite, or a life without addictive euphoria, in which he would have to work daily on his responsibilities. He was a man caught between a life of comfortable failure and a strange, difficult path toward new growth, a path on which significant rewards, however abundant, would be slow in coming.

As it turned out, Sam was not yet finished finding a bottom in his life of addiction. He sat out his four weeks in the hospital, mostly in angry silence. He listened but took little part in group therapy. He never seemed to accept completely the idea that he might have other addictive problems. I made one final effort to talk with him alone after group one day, but he stormed away saying something like, “You’re a professional and you’ve had a good life. People like you who never had a gambling problem could never really understand a compulsive gambler’s real needs!”

Two weeks after he left our program, his wife called to say that Sam had been in an auto accident while drunk, and that he had ended up in an alcohol detoxification program. Shortly after that, I heard he made a serious suicide attempt, using drugs. Six months later, to my amazement and delight, Sam himself called to tell me that he had stopped drinking, and, while not attending Gamblers Anonymous, he was doing well in Alcoholics Anonymous. His son, at last, had been placed in a special school. The violence toward his wife, he said, had stopped. Knowing that I might have some doubts about all this, he put Liz on the phone. Her voice had joy in it, something I had not heard from her before.

I will never know what finally turned him around, but I think his experience in our program in Reno was not wasted. Sometimes people are listening even as they are busy denying their problems. We must never forget that people in denial are not deaf. Recovery is never a straight path, but I like to think that Sam at last had stopped trying to fix what was wrong inside with something from the outside. Perhaps he had finally given up the search for a substitute and decided to become a different person. Perhaps he was growing up.

The gambler in early recovery usually continues to feel that everything he or she does is only a means to some future goal. They seldom do things in which they can lose themselves completely because of this in order to kind of thinking. They cannot live in the present moment. For example, “I’ll just work extra shifts in order to pay my debts and earn some respect.” Or, “I’ll play golf in order to use energy and take my mind off gambling.”

Will self-destructive personality characteristics simply disappear when gambling stops, or do they linger on to cause further problems? Will resentment, entitlement, impatience, magic thinking, and selfish exploitation disappear if they are covered up with a substitute for gambling?

If we blindly substitute one behavior for another, if we substitute work or sports for gambling, are we in danger of leaving needed personality change undone? I think so.

Thus, although there is no single gambler personality, there is a frightening tendency among gamblers to suffer from multiple addictions, a dreadful tendency to substitute one addiction for another. That’s all. Substitution may be change, but it is not progress.

All thoughts of work vanished as I made my last turn and started the long descent into the Tahoe Basin. The first breath-taking view of the lake appeared. Cat’s paws moved across the deep blue surface. Mountains, trees, and rocks reflected on the calmer parts of the surface.

I can accept my own responsibility for inner tranquility, but sometimes that responsibility is made easier by choosing the right environments. Every time I saw this particular environment, I was grateful for my wife’s insistence on living here. Home never felt more like home than here.