The New Addicts

JENNY BROCKIE:    Welcome everybody, good to have you all here. Emma, can I start with you? Mum recently took your laptop away. Why did she do that?

 

EMMA:    Mum thought that I was spending too much time on it, and she realised that my behaviour was changing within the time.

 

JENNY BROCKIE:    OK, so how much time were you spending on it?

 

EMMA:    Probably, like, from the time I got home from school to when I was supposed to go to bed.

 

JENNY BROCKIE:    OK, and how long was that? From about 4:00 or something like that?

 

EMMA:    About 3:30 to 9:30.

 

JENNY BROCKIE:    Solid? The whole time?

 

EMMA:    Yes.

 

JENNY BROCKIE:    What about dinner?

 

EMMA:    Yeah, I just went out to have that.

 

JENNY BROCKIE:    OK, so you would just take a break for dinner. What were you doing online? What were the main things you were doing?

 

EMMA:    Um, well, some is gaming and then MSN and yeah...

 

JENNY BROCKIE:    Alright, Penny, what were you worried about?

 

PENNY:    I think, Jenny, my main concern and Steve my husband's concern for Emma was as a parent, or as parents, just the time she was spending on there.

 

JENNY BROCKIE:    She said you were worried about her behaviour change?

 

PENNY:    Absolutely. You know, at 12, their behaviour changes anyway, we know that. But unfortunately, yeah, I did feel that it sort of accelerated with the computer.

 

JENNY BROCKIE:    So, what accelerated exactly?

 

PENNY:    Just her behaviour and her being withdrawn and not communicating with other family members and not wanting to be with us. Spending time with us and sitting and hanging out in the lounge room or stuff like that.

 

JENNY BROCKIE:    How did it feel when it was taken away Emma?

 

EMMA:    I felt annoyed, but in the end, I just started to accept the consequences.

 

JENNY BROCKIE:    That sounds like mum had a good talk to you, by the sounds of things. I'm going to come back to you later on. Wayne, I want to talk to you, you're an electrician in Mount Isa. Tell us about the online game that you play and how often you play it?

 

WAYNE:    I play World of Warcraft. The same as the young lady, I pretty much play from getting home to bed time as well! Which is, for me, varies the time, but it probably averages about six or seven hours a night.

 

JENNY BROCKIE:    Six or seven hours a night solid?

 

WAYNE:    No, not solid. I bath my daughter and I get up and have tea, and if I need a drink, I'll get up and have a drink.

 

JENNY BROCKIE:    But it is pretty solid?

 

WAYNE:     Yeah, pretty solid.

 

JENNY BROCKIE:    What about weekends?

 

WAYNE:    That varies, depending on what we're doing, but I have spent pretty much most of a weekend playing.

 

JENNY BROCKIE:    Playing the game? Let's have a look at the game…Ok Wayne, tell us how it works.

 

WAYNE:    That was the Trial of the Crusaders, it’s a new instance that’s come out and it allows people to go in to the instance and kill the creatures that you saw.

 

JENNY BROCKIE:    OK, so you play this day after day, night after night, and pretty much solidly on weekends and time off as well?

 

WAYNE:    Yeah.

 

JENNY BROCKIE:    OK, what happens when updates to the game come out?

 

WAYNE:    I have taken rostered days off, taken holidays to go and get the releases of the game and you just put it into the computer and it loads up and you continue playing.

 

JENNY BROCKIE:    Lee, how hard is it to get it into the computer?

 

LEE:    It depends. Sometimes it's very hard, but others, I guess the nagging helps!

 

JENNY BROCKIE:    And what happens when you go on holidays?

 

LEE:    It's not so much now, but he used to get very...he wanted to play…go to Internet cafes and play, but now it is a little settled down.

 

JENNY BROCKIE:    What is it, Wayne? What is it that keeps you at the computer?

 

WAYNE:    That's a good question. Um...playing with your friends that you meet online. Trying to always get a better gear or get another level. Or just having fun on the game.

 

JENNY BROCKIE:    How long have you been doing this for?

 

WAYNE:    It came out 2004, November. I think I started playing in December 2004.

 

JENNY BROCKIE:    There are a few jaws dropping around the room, I've noticed as you've been describing this. Lee, you started playing.

 

LEE:    Yeah.

 

JENNY BROCKIE:    So you could be with him? Is that right?

 

LEE:    Yeah, he used to play a lot, and we didn't have a child back then. And for quality time, I did start to play with him.

 

JENNY BROCKIE:    So, quality time? What sort of quality was the time?

 

WAYNE:    It was quite enjoyable to play with him. I guess, it's like sitting down and watching a movie with your partner.

 

JENNY BROCKIE:    So, how often do you play?

 

LEE:    We have a young child now, so I don't play as often. It really depends day-to-day. When she's asleep is when I can play.

 

JENNY BROCKIE:    I was going to ask you what she does when you're online for six and seven hours a day? I mean, what happens then?

 

WAYNE:    She's usually in bed by then. Her bed time is 6:30, so we'll bath her at 5ish and I'll spend time with her during that, and when she's in bed I'll play. But during the weekend, she's just quite happy to run around the house and tear it up! So I just play and keep an eye out for her and make sure she's not getting into things she shouldn't be.

 

JENNY BROCKIE:    OK, Wayne, what's the longest you played at a single stretch?

 

WAYNE:     I think it was about 30 hours, I think.

 

JENNY BROCKIE:    30 hours! What, without sleep?

 

WAYNE:    Yeah, without sleep.

 

JENNY BROCKIE:    What about meals?

 

WAYNE:    Yeah, I eat meals. I used to smoke back then as well, so I would go out every hour for a smoke break. If I needed to go to the toilet, I was more than happy to get up and go to the toilet.

 

JENNY BROCKIE:    OK. We're getting some strong reaction around the room. I mean, how do you feel telling the story to all of the people who are gasping and oohing and aahing about it.

 

WAYNE:    The fact that the game’s got…the last time I checked, the game has something like 16 million players. It's not as uncommon as people think and if everyone asked in their group of circles, I bet everyone would know someone who would play.

 

JENNY BROCKIE:    Nods, people are agreeing. Andrew, you're a psychologist and you've treated people with excessive online gaming habits and playing games. You've described the game that Wayne and Lee play as the crack cocaine of online games. Why?

 

DR ANDREW CAMPBELL, UNIVERSITY OF SYDNEY:    Well, I first can't lay claim to that quote. That was something said some years ago about World of Warcraft, but it is something that I do subscribe to. It's one of those games that has all of the reward conditions in place. It's got compelling graphics, great music. A rewards system of getting items, gold, prestige. You're interacting with other people all the time. It's socially reinforcing and it's compelling and it's usually something that you could say chews up your time when you least expect it.

 

JENNY BROCKIE:    So, is Wayne's behaviour addiction?

 

DR ANDREW CAMPBELL:    To be honest, it's very hard to determine. Now, the reason that I say this is because there's two models. One is pathological Internet use, which is a person like Wayne who might spend 30 hours. But let's say that was a one-off. So that wouldn't constitute addiction, necessarily. That was a unique instance. The other one is an obsessional model which says that there is a period of time where Wayne will suddenly go - I've had enough of this game, and he can actually walk away, simply because it is not giving him the rewards that he needs any more.

 

JENNY BROCKIE:    OK, have you ever felt like that Wayne?

 

WAYNE:    Yeah, from his explanation, I believe it is an obsession. There has been times where you just get annoyed with the game and you just leave it. We've been up in Brisbane for this show for a number of days and I haven't felt the need to play or the urge to play. So, you can walk away from the game. Or, I believe I can walk away from the game.

 

JENNY BROCKIE:    Kerryn Rubin in Melbourne, you're a psychiatrist. I'm interested in what the worst example of people playing games online is that you've seen or that you've come across?

 

DR KERRYN RUBIN, ST VINCENT’S HEALTH, MELBOURNE:    Look, I gets I've seen a wide variety of different things, and it's not just games, I guess. We've spoken a bit about Facebook, and for some people, it might be pornography, so it’s a whole range of different behaviours that people access the Internet. Probably the ones that I'm most concerned by is people who neglect their physical health. So somebody I had seen who would have played for sometimes 48 hour stretches, not taking medication for physical issues and actually becoming physically quite unwell as a consequence of that.

 

JENNY BROCKIE:    And there have been examples of that overseas, haven't there? There have been stories that have come from places like South Korea and China where there are real concerns about people's health? Yeah?

 

DR KERRYN RUBIN:    Certainly, I guess in China and South Korea and Taiwan, there have been reported deaths, which were felt to be due directly to people who were spending... I think the Taiwanese one was three days without a break and one of the South Korean ones was 51 hours without any break except going to the toilet and a few energy drinks and the thought was basically that the people died of exhaustion. Cardio pulmonary arrests.

 

JENNY BROCKIE:    At the keyboard?

 

DR KERRYN RUBIN:    Yes, in the gaming. With at least a few of the examples that had been at Internet cafes, so people had died in the cafe.

 

JENNY BROCKIE:    Kerryn, you've treated people who have problems with Internet use. Do you think that it can be classified as an addiction? Do you think that it fits that kind of picture?

 

DR KERRYN RUBIN:    Look, my response would probably be the same as the response before. I don't think it personally that it fits the classical addiction model, and whether one thinks of it as an obsession. There's a concept of impulse control disorders and that's currently how we classify things like pathological gambling, which the lay public might call gambling addiction, but it has different features to classical addictions such as alcohol and heroin and things like that.

 

JENNY BROCKIE:    What do you think the difference is between an obsession and addiction?

 

DR KERRYN RUBIN:    Look, I think it is one of the very hard to define things, and we might talk about things like brain chemistry and things like that. The underlying cause. We're talking specifically about computers and the Internet, part of where it gets complicated is that we're looking at a number of different things and we can think of the Internet use as a symptom of some kind of underlying problem. Much of the time, for some people it may actually be related to depression. For other people, it may be related to social anxiety. For some people, it is more of an impulse control disorder where they develop an obsession with the game. As opposed to substances where the person has a direct physiological addiction, so their concepts such as tolerance and dependence, where the person actually experiences direct physical negative effects of not having a substance that they're dependant on.

 

JENNY BROCKIE:    David, I know that you play online games as well. Tell us what you play and what do you think listening to Wayne's story?

 

DAVID:    I can certainly relate to Wayne. I actually stopped playing World of Warcraft six months ago, but I also played Release from November 2004, and I also have a young family. I have a five-year-old daughter and an eight week-old daughter. I've always felt that if I was on my own, I probably would have let the hours that I put into World of Warcraft get away completely and I would have been completely swallowed up by the game.

 

JENNY BROCKIE:    Why?

 

DAVID:    Just, I think, you get such frequent rewards. They give you a test. You get a reward. You get a small thing that makes your avatar better, and then they give you another test, and you get another reward and you keep on feeling like you're improving, and the whole thing behind World of Warcraft is that they want you to keep improving your character and feel like you're achieving something. And that feeling inside your body, you just keep wanting to get better, get better and do more. That was the original reason. But the second reason was the social aspect. There's a whole social structure in World of Warcraft, ranging from people who just start the game, to elite raiders who you try to match as far as achievements go, and basically, you enter the system and you get involved in it. It is like a social thing, you know.

 

JENNY BROCKIE:    OK, Andrew, how much is that like gambling?

 

DR ANDREW CAMPBELL:    Yeah honestly, very close similarities. First of all, if we just look at the simple one of reward. In gambling, it is a monetary reward, but funnily, there has been studies that show that the monetary reward highlights parts of the brain. The brain basically lights up in similar ways in similar ways to people who play World of Warcraft or other multiple massive online games or MMOs. It's definitely got the aspect of achieving something and feeling as though you're successful at something and that it is your skill that's doing it.

 

JENNY BROCKIE:    Lynette, I want to broaden this out abit. You had a different problem, tell us about that any whether of this and whether any of this sounds familiar to you, given the problem that you had?

 

LYNETTE:     Sure, my problem was low self esteem which manifested itself in, for me a lot of stress in my life. And I found in order to deal with the stress, I found myself literally addicted to eating, because when I ate, I felt better. Now, from listening to the World of Warcraft where you improve yourself as a person and you fell better and you feel better, I can hear that…i'm not saying that there’s are self-esteem issues -  but I can hear the self-esteem being improved. And my feeling of self-esteem led me to eat in order to dampen down my stress, which made me feel better.

 

JENNY BROCKIE:    And when you say overeating, how much were you overeating?

 

LYNETTE:    I could down a couple of bags and chips and a couple of chocolate bars in one go or are if I cooked a meal and it might have been spread over a few nights. If I was upset, I could have easily eaten that in one go. I was never hungry, it was just in a way to help me cope and feel better, and unfortunately it did. It did make me feel better in the short-term, but then clearly afterwards, then you have to deal with all of the guilt and all of those issues as well.

 

JENNY BROCKIE:    Kerryn, would you classify that as addiction?

 

DR KERRYN RUBIN:    Once again, I wouldn't be classifying that as addiction, but certainly what Lynette is saying is very connect today what we were talking about before. That generally these behaviours indicate that there is some kind of underlying problem, and that some kind of specific need is being met. Now, obviously, I'm not making a comment about any of the specific people who are here today, but certainly in my experience, often I encounter problems with depression, self-esteem, social anxiety. And people then utilise these mechanisms be it for some people eating, or for some people it might be computer games as a means of managing their own stress and anxiety.

 

JENNY BROCKIE:    Jon, I'm interested to hear what you think because you're a neurologyist and an addiction specialist. You treat mainly drug addict addicts, but do you think that you can addicted to Internet games and food and other things?

 

PROFESSOR JON CURRIE, ST VINCENT’S HEALTH, MELBOURNE:     Absolutely. As we listened to it, one of the features that everybody is bringing out is the pulses of reward and as you get more and more of these, so you want more and more and it keeps going. The interesting thing is that yes, some people start because of self-esteem or depression. But other people start because they just start and there was no problem underlying it, you just loved it, and then away it goes. For some people, the important thing is - can you stop? Is it that you can put limits on it without necessarily taking away the computer or something like that? And this is where the borderline between addiction and others comes.

 

JENNY BROCKIE:    Emma Kate, what do you think listening to all of this? When you were on the computer all the time, could you stop, or did mum have to stop you in the end?

 

EMMA:    No, I could stop. I don't find myself necessarily addicted.

 

JENNY BROCKIE:    I'm sure you weren't addicted. But it's interesting territory here that we're going to explore a little bit later on about the whole idea of modelling behaviour or getting into habits with behaviour which some of our experts are nodding about. I'm just interested too, though, in the rest of the audience here. Because you've all gasped about Wayne's game playing and everything else, but I wonder how many of you might think that you have obsessions, habits or addictions, whatever up want to call them to particular things. Caroline?

 

CAROLINE:    Yeah, when I was back in uni, you could call it addiction or obsessed with or drinking Diet Coke. I was working three jobs, I would get up at 4:00 in the morning to work a morning shift and go to uni and come back and have a bit of a rest and then go and work at a waitresses serving job. And to keep me going, I was drinking Diet Coke with the caffeine in that.

 

JENNY BROCKIE:    Yeah, but a lot of people do that. We have to be careful about pathologising things here. How many cans of Diet Coke were you drinking a day?

 

CAROLINE:    Up to 10 or 11 a day. It was available to me, you know at the restaurant and in the morning instead of reaching for a cup of coffee, I was drinking Diet Coke.

 

JENNY BROCKIE:    Sonu, what about you?

 

SONU:    I'm having an addiction of shopping. Whenever I get upset or I get depressed, I always go for shopping, and you know, you don't even know that. Even I don't have even time for the shopping. I just go for that.

 

JENNY BROCKIE:    Because it makes you feel good?

 

SONU:    Yeah, it makes me feel better. It makes me feel very good. But later on, I realised that whatever I'm doing is really, really wrong. I just shopped till I dropped!

 

JENNY BROCKIE:    OK, the danger here? The danger that we're pathologising things, where the word "addiction" gets thrown around an awful lot.

 

PROFESSOR JON CURRIE:    Absolutely, and I think it comes back to the stopping and what is it doing to you? And when it becomes so, if you like, you can use the word obsessed, but when it is all-consuming and it starts to damage you and the relationships around you, that's when you have to look and say, why aren't the normal mechanisms kicking in to say this is silly or this is dangerous or bad, and that’s when it is becoming a problem.

 

JENNY BROCKIE:    Ben, you're 25. You've had a 10 year battle with addiction. Let's hear what you told our producer about that.

 

 

 

 

BEN’S STORY:

 

 

REPORTER:    Ben was 15 when he first started smoking marijuana.

 

BEN:    I loved everything about it. I loved the way it tasted. The way it smoked. The way it smelt. It became a daily habit straight away almost.

 

REPORTER:    The habit turned to dependence.

 

BEN:    I would feel lost. I would feel sad. I wouldn't know what to do with myself. I would get anxious and lonely and bored. I would be agitated. I would wonder when I was going to getting my next one. I would fantasise about how I was going to get it and where I was going to get to get the money from.

 

REPORTER:    At 17, Ben began injected Methamphetamine.

 

BEN:    You physically needed it to feel whole again. Without it, you were a depressed wreck.

 

REPORTER:    Ben injected for two years before breaking the habit and going cold turkey. But at 21, he began smoking ice.

 

BEN:    I could smoke $1,500 away in one night, and then have nothing for the week. I would have killed for it. I would have killed for it.

 

REPORTER:    As well as addiction to drugs, Ben has a love of computer games.

 

BEN:    I got the same adrenaline rush from it as I would from speed and my compulsive behaviour. I got the same amounts of anger for a game not going my own way. I had to have it. You get a high out of it. You get a feeling from it. You just to get off shaking with this big rush out of it. I wasn't paying my bills. I wasn't eating. I wasn't drinking. I would smoke cigarettes, I would smoke so many cigarettes and I would just sit there and play. You know, you forget to lead your life. You forget about life. And I'm an addict. I'm a full-blown chronic addict. Yeah. I can get addicted to anything that gives me joy. I can get addicted to tupperware if I liked it. That's the funny thing with addiction.

 

 

 

 

 

JENNY BROCKIE:     Ben, why do you think you get so easily hooked on so many things?

 

BEN:    Because I’m an addict, I’m…I suffer from the disease, I believe that I suffer from a disease. In a way it fills abit of a void I’ve had in me for a very long time. It ‘s a bit of an escape, even with the gaming and the internet.

 

JENNY BROCKIE:    See, I’m interested in this because we accept that things like cigarettes and ice are addictive, but as somebody yourself who describes yourself as an addict, I’m interested in how you compare the experience to the experience with playing those games.

 

BEN:    I don't think there is too much of a difference to be honest with you. Some people might think differently, but for myself, it's exactly the same. I've got rid of the PS3 and I'm playing World of Warcraft now and I've been playing for ten days.

 

JENNY BROCKIE:    You’ve just bought the game that Wayne’s got?

 

BEN:    Yes, I have. And I'm thoroughly enjoying it to be honest with you. I don't know. You sort of... It's an escape, and for me, a lot of the gaming use was an escape from the drug use as well.

 

JENNY BROCKIE:     So, you've replaced one thing with something else in a way?

 

BEN:    No, I've got to have a little bit more control over it. It is not about having control of it, though. I have to accept that that is who I am and try to use that more constructively and not forget about life. I've worked for a long time and it just took everything from me.

 

JENNY BROCKIE:    Jon, what happens to the brain when somebody becomes addicted?

 

PROFESSOR JON CURRIE:    What we see are tremendous changes in the chemicals. That is the chemicals which are released around the brain, but also the structure of the cells and the connections between the cells themselves. And these are different in different people. So, it's very important to recognise that not everybody who plays a computer game is going to get addicted. But there is a small group of people who, when they are exposed, will go on and develop this kind of behaviour. And it fills this pattern and their brain is changing with this. It particularly changes obviously with the drugs like alcohol and cannabis, as we saw, but it can also change just with these repeated rewards.

 

JENNY BROCKIE:    Dan, you've analysed the brains of addicts. What happens to their impulse control?

 

ASSOCIATE PROFESSOR DAN LUBMAN, ORYGEN YOUTH HEALTH RESEARCH CENTRE:    That's a very good question. If we look at it, and Jon has talked about it and others have talked about it. If we look at what we mean by addiction and it is good to be clear here, that often the term addiction is banded about, and sometimes people can trivialise the experiences that people can have, and we can all be addicted to something. But when we're here talking about addiction, we're here talking about a really significant condition where the key behaviours are a lack of control or problems controlling the behaviour or controlling their use, and repeated failed attempts to actually reduce or stop using. And then if we look at that sort of indicates that, well, what part of the brain is actually involved in regulating behaviour. We actually find that the front part of the brain is very important for everyone here in terms of decision-making, making decisions about long-term versus short-term consequences. Thinking about what we want in the future. Making sure that our behaviour is in line with those goals and making sure we stop behaviour that we don't agree with, and certainly we and other people, both here and internationally have done a whole series of studies looking over the last 10 to 20 years in people with long-term addictions and find quite marked problems in the frontal lobe of people who develop addictions.

 

JENNY BROCKIE:    And are those problems in the frontal lobe things that people are born with or is it something that develops? This is a big question, isn't it?

 

ASSOCIATE PROFESSOR DAN LUBMAN:    It is a brilliant question, and hopefully we're on the way to trying to understand that. Certainly what we know, if we look across a whole range of addicted populations for a range of different substances, including populations with severe problem gambling. What we fine is that part of the brain, the front part of the brain finds it very difficult to actually monitor and regulate behaviour. So, when you want to do something, you find it very difficult if it is sort of overwhelming urges and feelings to want to go and do that, like we've heard. It is very hard to stop that behaviour.

 

JENNY BROCKIE:    A fine line, though, between people finding themselves in that situation sometimes and tipping over into just not being able to stop, yes?

 

ASSOCIATE PROFESSOR DAN LUBMAN:    It is. When we're talking about addiction, like John said before, we're talking about people who continue to do this behaviour despite knowing the impact it is having on them, their loved ones and people around them. They continue doing that and they know they shouldn't do that and promise everyone they’re not going to do it. But when they're trapped in the moment, they fine it almost impossible to stop.

 

JENNY BROCKIE:    Wayne, did you ever find that?

 

WAYNE:     Not really, I found that every time Lee asked me to do something, it might take me sometimes up to an hour to take the rubbish out or something like that, but there are certain things that as soon as she asks me to do them, I'll do them. So for example, any time she asks me to do something with the daughter or change her nappy or get her out of the shower or something, I'll do that.

 

JENNY BROCKIE:    OK, Dan, I know that you did a test where you showed drug addicts and non-addicts pictures. Can you tell us what the test was and what it showed?

 

ASSOCIATE PROFESSOR DAN LUBMAN:    Sure, the area of the brain that we were interested in was the area of the brain involved in controlling behaviour, but the other area that Jon and others touched on is the emotional part of the brain. The part of the brain that's involved in urges and drives and motivating us towards certain behaviours and what we know as Jon has already alluded to, is that drugs hijack that system. They make that system activate. They increase the amount of chemicals in that system, and so, we've been interested to look at how the system responds to images associated with drugs and taking drugs compared to other activities that you and I and everybody else would find exciting, so here we have some examples of some of the drug pictures that we showed people. We and others found that people who are long-term heroin addicted, the brain really gets excited by these images. Even if they themselves aren't interested in the task that they're performing, the brain really lights up. At the same time, when we showed them images that are meant to make people feel pleasant and pleasurable activities that you and I would enjoy, at the same time, those same individuals showed an under response to those normal pleasures. So there is an a imbalance here between pleasure that we all get and the pleasure derived from addiction, and it is that imbalance from not having enough pleasure from everyday rewards and too much to drugs that predicted who would be an addict over the next six months.

 

JENNY BROCKIE:    Lisa, you're a recovering gambling addiction and alcoholic. Does that sound familiar at all?

 

LISA:    It is music to my ears. I love hearing this because I believe it is something that I had no choice over. I went into rehab seven and a half years ago and gave up smoking, drinking, gambling and drugs on the same day, which was not pretty for quite a long time. But today, I have a life that I would encourage anybody to have. I believe that it is an illness. Certainly for me, I believed it was an illness, and there was no off button. It didn't matter what it was. There was no possible way that I could stop gambling or drinking when I started.

 

JENNY BROCKIE:    Did you have a trouble controlling impulse? Was that a problem for you? Were you impulsive?

 

LISA:    I would probably be described as being impulsive, I guess. But just in keeping it in the context of the addictions that I have, if I started, I didn't stop. I stopped when I blacked out, fell down, there was no money or no alcohol left. That's when I stopped.

 

JENNY BROCKIE:    Jon, the big question that everybody wants answered is why some people turn into addicts when others don't. You know, if they're exposed to things like alcohol and so on. Why do you think some people turn into addicts, when the majority of people don't?

 

PROFESSOR JON CURRIE:    Right, incredibly difficult question, but essentially, there is a small group who will go on exactly as you've described. There are a large number of people who can have a drink, have a smoke and then they can stop, and it seems to be a combination of your genes, the stress you're under and your environment and how your brain is structured. So all of these together mean that certain people, if you like, are walking timebombs. They will have this problem occur. Other people can stop relatively easily, and it is this difference which is the important thing.

 

JENNY BROCKIE:    And this idea that addiction is a disease? That it is something that you're born with or you get genetically? What do you think about that?

 

PROFESSOR JON CURRIE:    We subscribe to that very strongly, simply because from a practical point of view, this is what we treat everyday. We see it. We see people with tremendous difficulties stopping, but with a combination of counselling and medical help can stop. The other thing is that the gambling is interesting. In patients with Parkinson's Disease which is the tremor and difficulty moving, when some of the Parkinson's people are treated with deep brain stimulation, they develop pathological gambling when they never had it before. So stimulating an area of the brain for treatment in Parkinson's can develop pathological gambling.

 

JENNY BROCKIE:    But not all children of addicts become addicts?

 

PROFESSOR JON CURRIE:    Absolutely, and that's because there are environment and all of the things that can stop that happening. It is not just genetics. It is the combination.

 

JENNY BROCKIE:    OK, Gene Heyman, welcome from Boston it’s good to have you with us. You're a psychiatrist and you have looked into addictionas well, what do you think drives it and what do you think about this discussion and it being a disease of the brain and so on?

 

DR GENE HEYMAN, McLEAN HOSPITAL, BELMONT USA:    Thank you. I'm actually a psychologist, and let me tell you a bit about what I found. I started in this area with much the mindset that I've just heard from Dan and Jon. But what I did was look at recovery rates in people who met the American psychiatric criteria for addiction, which I believe would be the same as in Australia. And it turns out that addiction is the psychiatric disorder that has the disorder with the highest recovery rate. This fact has been missing from this conversation. Most people who meet the criteria for addiction no longer do so by about aged 30. This is not to deny that there isn't a genetic pre-disposition. We know that for sure with certain forms of alcoholism, but given that data, I then asked the question about what led to these people recovering? Was it going to treatment, for example? And it turns out that most people who stopped using drugs, and we're talking about drug addiction now, well, I am. They actually don't go for treatment. The view we have of addiction, and that's what we're hearing now is largely based on clinical populations, which turned out to be a minority of the people who meet the criteria for addiction. And the issue of persistence which comes up, which is a really interesting question and I think a key question, could be answered by looking at the clinical populations. Because they turn out to use much longer than the non-clinical populations, and what the data shows is that the basic difference between the clinic populations and the non-clinic is the additional psychiatric disorders or the non psychiatric illnesses. And that fits into a much larger picture of, what is it that typically leads people to quit drugs or quit gambling or stop using the Internet, and that's the presence of competing activities of other choices, getting married, children, losing a job, fear of arrest. All of these factors are the ones which influence people to stop using drugs, and...

 

JENNY BROCKIE:    So, Gene are you saying that it’s a choice? Are you saying that people make a choice?

 

DR GENE HEYMAN:    Yes, and the reason I say that is that the factors that influence people to quit drugs are the factors that influence our choices and they're not the factors, for example, that would stop a schizophrenic from hallucinating, or stop someone with tourette's syndrome from having verbal ticks or physical ticks, the kinds of things having a child doesn’t make someone stop playing on the Internet or I better stop using heroin so much. But it does stop people from using drugs.

 

JENNY BROCKIE:    OK, Gene, I'm going to have to stop you there because we're running short of time. I want to get a reaction from Dan there. I'm interested, if people are giving up drugs because of family reasons or jobs or giving up other things because of those reasons, does it point to choice? Does it suggest that?

 

ASSOCIATE PROFESSOR DAN LUBMAN:    I think Gene makes an excellent point. The issue here is the issue of looking across the spectrum of addiction. You know, it's like any disorder. We think about depression and we think about self help and getting support or able to get treated. Nowhere near any kind of practitioner or any sort of health professional. And then we have people with severe depression because they have other things going on in their life and it makes it much more difficult for them to get help and they have to go and get much more expert help in different settings. The same with addiction. And I think as Gene said, I think some people, if the support in the family or the community is enough, they can stop. But for others, if they have other things going on, if they have other things as Gene said, if they have parts of the brain that actually are also involved in addiction, it makes it very difficult for them to stop.

 

JENNY BROCKIE:    Gene, I'm very interested in what you said about the clinical and non clinic people, the idea that the research is a bit skewed because you're looking at people who go into treatment, rather than people who give up of their own accord. And I wonder if there is a category of people who gives up of their own accord, where does the idea of appealing to will power fit in to all of this? Do you think that's an issue?

 

DR GENE HEYMAN:    Well, I think that's a word that we use and we use it to describe choice. But what we see is that it’s a question of what the alternatives are that people have that what we call will power is that somebody has a good reason for doing something. And so, it doesn't come out of the blue, but it comes out of the context, and it also comes out of their own, it could be genetic factors that allow them to see things in their environment that other people don't see, so I think it is a combination of factors that influence their choices. But when we say will power I think we’re really saying is that they have some reason for doing something and they have a good reason and they're willing to go through some pain. I think I'd just like to add one more thing. If we assume, if we observe the addiction as a choice, it will mean that there has to be a period of time right after you quit using drugs that things are going to be worse because drugs were making things better, at least in a local condition. And so, people need help through that transition, and that's where we say they need will power but I think what we're really saying is that they have something to live for, and a reason for doing so.

 

 

JENNY BROCKIE:    Robert, you ran a private rehab clinic in Adelaide where Ben was a patient. How do you treat someone like Ben who listed a string of things that he's been addicted to?

 

ROBERT MITTIGA, THE GATS PROGRAM:     Look, this is not uncommon in the last ten years that I've been in this field. Most people we see come in have clusters of addictions. Often interactive. Someone like Ben is something we see a lot.

 

JENNY BROCKIE:    So how do you treat it?

 

ROBERT MITTIGA:    First of all, our philosophy is abstinence, so we need to bring them into private treatment, to what we call in-residence treatment, where they put boundaries around the people. We have medical interventions where needed, especially when it involves certain types of drug abuse or alcohol. There needs to be medical interventions or detox, medical detox, etc, just to make sure that the person is safe. They come into treatment. Once they're clean, so they need to be clean before they come in, so once the medical intervention has occurred, then they come into rehab. First few weeks, one of the things that we do in the GATS program is we look at addiction treatment holistically, so we look at the whole person. So we need to look at it from a...

 

JENNY BROCKIE:    So, background…

 

ROBERT MITTIGA:    Background is extremely important. So emotionally, physically, mentally and what I would call spiritually.

 

JENNY BROCKIE:    So, a lot of talking? Is there a lot of group?

 

ROBERT MITTIGA:    When I say talking, it's a lot of group psychotherapy, which is not necessarily cognitive work. We tend to work more at the emotional level with the clients. My belief and my experience is that…and if you look at this neurologically, you'll see the emotional part of the brain and the award pleasure-seeking part of the brain is in the same area. So, my belief and my research shows that those two are closely connected, if you put it that way. And I often say to my clients, you're not going to think your way out of this problem. You're going to feel your way out of the problem. In other words, we have to help them develop their emotional structure.

 

JENNY BROCKIE:    OK, Ben, what's it been like?

 

BEN:    Oh, it's been great. I came in there not wanting to talk to anybody, and I can get up in front of a hundred people now and talk as normally as I would have as a kid.

 

JENNY BROCKIE:    But, you're still playing that game?

 

BEN:    Yeah, but you know, that's not going to hurt my life. You know, we're talking about stuff... Not so damaging. Drugs were damaging, life damaging, life altering and mind-altering. And it really hurt the people around me.

 

JENNY BROCKIE:    Robert, what do you treat as addictions? What do you regard as addictions?

 

ROBERT MITTIGA:    Can I give you my definition of addiction, and one used by the World Health Organisation in the past, and that is a pathological relationship to any mood-altering experience that has life-damaging consequences and is continued to be used despite the consequences.

 

JENNY BROCKIE:    What does that include?

 

ROBERT MITTIGA:    In my book t can include anything. Most of the addictions we see are gambling, drugs and alcohol, of course. Sex addiction we're seeing a lot of, especially Internet pornography. Lots of problems and life-damaging problems coming out of that. Sex addiction in itself I think is a very interesting addiction, because you don't need to injest anything. I believe it is... A person with sexual addiction can already start to get high, just the thought of acting out. OK, so it is an interesting neurological, biological and chemical reaction.

 

JENNY BROCKIE:    OK, Kerryn, listening to this, given the premise or the starting point for this program is, what is an addiction and whether we're going too far here and including too many things here in this definition. What do you think?

 

DR KERRYN RUBIN:    I think first of all, fundamentally I agree with what Jon and what Dan were saying before, that at the extreme end, we're clearly dealing with dysfunction that is going to have a brain link, will have a genetic basis, as well as people's upbringing and the general environment that they're in. And then, I think it becomes a question of semantics, so really what's important to me is - does somebody have a problem that's causing a really significant and negative impact on their life. And if they do, we try to work out what can be done to help that person. So obviously, we look at ruling out if there are other problems like depression and anxiety, or is it primarily, as John was positing for some people, which I’m not…generally the people that I see, that the problem primarily came from being exposed to something, which they then became, whether we call it addicted to or have impulse control. Problems that become sent antic.

 

JENNY BROCKIE:    Jon, you run a hospital-based treatment program, which is different to Robert. How do you treat addiction?

 

PROFESSOR JON CURRIE:    The first and most important thing is that there is no single treatment that will cure everybody, and the second thing is, as we heard from Gene, it's not getting them off the drug, it's keeping them off. So, what we run is a combination of the counselling, the support that we've heard about and a very powerful medical program which uses medications to alter some of the brain functions, some of the cravings which make it hard to stop. So, our aim is to make it as easy as possible to stop, and as easy as possible to stay off.

 

JENNY BROCKIE:    You wanted to say something?

 

LISA:    Yeah, just one of the things I haven't heard mentioned so far is that I'll speak for myself... I didn't know what the problem was. I knew that my life was out of control, and I knew that when I started I couldn't stop, but I didn't understand that that made me an addiction. I didn't understand that that made me a impulsive gambler or an alcoholic, and I didn't understand that there was help available and treatment available, and that the turning point in my life, when I realised that I could get help and get treatment and actually change the way I'd always behaved. My life has changed so totally, it's beyond my ability to describe it.

 

JENNY BROCKIE:    OK, I'd like to go back to where we began, because we started talking to Emma about mum taking away the computer, and I'm just interested because we've had this discussion range across a lot of things, Jon, you said that you're worried about excessive use of online games and on, and that you think that that does qualify as an addiction along with a lot of other things. What are the implications of that for kids and for parents and for people who are looking at the behaviour and probably sitting at home wondering if they should be worried about something, or is this really just that we're going too far?

 

PROFESSOR JON CURRIE:    Look, I think for the vast majority of people, you can use it safely, and it is not ever going to be a problem. But what you need is somehow to be able to monitor when it becomes a problem. And that is, as mum did there, that there was a problem and she was stepping in there. For you, there was no monitoring until you crashed and burned at the end.

 

JENNY BROCKIE:    Yeah, Dan, you had your hand up?

 

ASSOCIATE PROFESSOR DAN LUBMAN:    I think that's a really important point. The thing that we're hearing and the whole issue about addiction is that it is stigmatised. People are ashamed and there's a lot of theories about what causes it - poor will power and a lack of moral will. It is something that we don't talk about and admit to others, and not only is it important for us to think about our own behaviours and what are we doing, but what we know is that people around us, people who support us are often the first to notice when the behaviour is getting out of control, and so the important thing is that we need to up skill friends and family to actually come forward and say, look, you know, I'm worried about what's going on. Can I help you to think about where we can get help together.

 

JENNY BROCKIE:    Andrew?

 

DR ANDREW CAMPBELL:     Something that hasn't been discussed is the generational aspect. When we're looking at Internet disorders or anything to do with gaming, especially. We're looking at a new generation of people who are coming through and getting exposed to these things. And two things are happening. One is that parents aren't really aware of what the content of some games are, and what it is that children are actually attracted to. And two, we're also looking the generation itself, propelling it along, and that is that if we look at Emma, Emma said she was on MSN or social networking through Facebook, these are things that if you are detached from, you're suddenly ostracised from as well.

 

JENNY BROCKIE:    We are going to wrap up, but my last question is about a question about treatment for abstinence. Because that might work for drugs or it might work for cigarettes, but how does it work when you're dealing with sex or you’re dealing with food? How do you treat those sorts of things that are part and parcel of people's everyday life?

 

PROFESSOR JON CURRIE:    The answer is that you can have controlled use, as long as you have someone to help you do the control. And that is a possibility obviously that can be used.

 

JENNY BROCKIE:    OK, Robert?

 

ROBERT MITTIGA:    That is a very interesting question. I think when it comes to drugs and alcohol and gambling and those types of things, I believe that abstinence is really the only way to go, because addiction is a disease. I believe it is a progressive illness, so it progresses over time. There's one factor that was missing in the gentleman from the US, in his study, and that is these people that just stop drugs, OK, I would be very interested to see his study to see what happens to these people and do they switch to other addictions? Because I believe that addiction occurs on a continuum – in other words – people may stop using drugs and alcohol, but do they switch to gambling, or do they switch to sex, or do they switch to work?

 

JENNY BROCKIE:    Gene, can we get a response to that?

 

DR GENE HEYMAN:    We have looked at that. And typically it doesn't happen. I want to add one thing about treatment. I agree with what everybody has said, but in addition, I would ask them to really focus on providing people alternatives, because that's what the natural history of the disorder looks like, and that's what there are a number of very successful treatment programs that focus on that by giving vouchers and so on for having clean urines and that turns out to be, I believe, the most successful programs that are on the books right now. And I think it is the sort of the things that parents can do with their children on the Internet.

 

JENNY BROCKIE:    Wayne, I would like to finish with you. How do you feel listening to it, and how do you feel about your obsession with online gaming now?

 

WAYNE:    No, I'm going to continue playing! It has opened my eyes a little bit to definitely the family thing. My father said from the day dot that I should stop playing. But I go to work every day, I look after my daughter, I play football. So I don't think that it is life-damaging.

 

JENNY BROCKIE:    Lee, what do you think?

 

LEE:    I think it can be life-damaging. Not necessarily for him, because he can do other things, but there would be other people that can't do other things. They have to solely do that, so I think it can damage their life.