Why It’s So Hard to Kick a Gambling Addiction為什么戒賭這么難

We now know that gambling can be as addictive as drugs， but there are factors that can make it even harder to quit.

我們現在都知道賭博可能和毒品一樣容易上癮，但有些因素會讓戒賭比戒毒更加困難。

The International Classification of Diseases （ICD） is the text produced by the World Health Organization that summarises all the medical issues they recognise.

《國際疾病分類》（ICD）由世界衛生組織編制，匯總了已經確認的所有醫學問題。

When the latest version， the ICD-11， was produced， the section concerning addictive disorders included a category for addictive behaviours. It’s now medically recognised that people can become addicted to specific actions and not just substances. Chief among these behaviours is gambling.

最新版本ICD-11發布時，有關成癮障礙的章節納入了成癮行為這一分類。如今，醫學界已經認識到，人們不但會對某些物質，還會對特定行為上癮。這些行為中最主要的是賭博。

Gambling addiction is undoubtedly a real thing and a big problem. Hence， the UK government is bringing in measures to hopefully curb， or at least reduce， the harm it does.

毫無疑問，賭博成癮確有其事，而且問題不小。因此，英國政府采取措施，希望能夠遏制或者至少減少賭博造成的危害。

But how do people end up addicted to gambling？ And why is it often so difficult to treat compared to more ‘typical’ substance-based addictions？

可是，人們是如何沉迷于賭博的？與更“典型”的物質成癮相比，為什么賭博成癮往往如此難以治療？

The ‘how’ is relatively straightforward. The primary appeal of gambling is essentially obtaining large amounts of money for next-to-no effort. When it comes to making decisions， the human brain is constantly weighing up effort against potential reward. If something ends up being heavily skewed towards the latter （for example， paying a small amount of money to receive a large amount in return）， we tend to really approve of it.

相對來說，“為何沉迷賭博”的答案并不復雜。從根本上講，賭博的主要吸引力在于幾乎不費吹灰之力就能獲得大把金錢。人類大腦在做決定時會持續權衡付出的努力與潛在的回報。如果某件事情的最終結果大大偏向后者（例如，花少量金錢獲得可觀回報），我們往往會非常認可這件事。

There’s also the fact that the human brain is complex enough to recognise money as significant， in the biological sense， even though it’s technically an abstract concept. Our brains also prioritise novelty and unpredictability.

還有一個事實是，人類大腦錯綜復雜，足以從生物學意義上認識到金錢的重要性，盡管嚴格講金錢其實是一個抽象的概念。再者，大腦會優先考慮新穎獨特與不可預測的事物。

All this together means that gambling can， and does， have the same effect on the brain’s reward system as certain drugs and substances. An addiction develops， with all the subsequent consequences for the individual.

總而言之，賭博可以——而且確實會——對大腦的獎勵系統產生與某些藥物和毒品相同的影響。成癮會不斷加劇，帶給個體一切后續影響。

This doesn’t happen for everyone who gambles， of course. A lot of people don’t gamble at all. Many people are instinctively averse to risk or loss， which are unavoidable aspects of gambling. But other people aren’t sensitive in this way and are far more willing to embrace gambling as a pastime.

當然，并不是每個賭博的人都會上癮。很多人根本不賭博。很多人出于本能對風險或損失感到厭惡，而風險或損失在賭博中不可避免。而有些人在這方面并不敏感，更樂意將賭博視為一種消遣。

But while the similarities between our brains’ responses to gambling and drugs can explain why gambling is so often addictive， it’s the differences between them that can make a gambling addiction particularly difficult to treat.

然而，雖然大腦對賭博和毒品的反應相似，可以解釋為什么賭博常常令人上癮，但正是這兩者之間的差異使得賭癮特別難治。

As a gambling addiction lacks any biological substance， it’s easier to miss or hide. As a result， some evidence suggests that 90 per cent of gambling addictions go unreported and untreated.

由于賭博成癮不依賴任何生物物質，所以更容易被忽視或隱藏。由此，一些證據表明，90%的賭博成癮隱而未報，也未獲治療。

Also， the lack of any specific substance underpinning gambling addiction means there’s nothing to ‘take away’， so to speak. Even for long-term， chronic drug addictions， there’s the option of removing the drug （going ‘cold turkey’） and allowing people’s brains and bodies to adjust to the absence. Granted， this is often a deeply unpleasant—even dangerous—option. But it’s still an option.

此外，賭博成癮缺乏任何特定的物質支撐，因此在治療過程中可以說沒有什么可“戒除”。即使是長期、慢性的藥物成癮，也可以選擇停用（“突然戒斷”）藥物，讓大腦和身體適應這種缺失。誠然，這通常是一個很不愉快——甚至非常危險——的選擇，但畢竟是一種可選方案。

That isn’t the case with gambling. It’s an action， not a substance. As long as someone has money and autonomy， it’s extremely difficult to deny them access to gambling. Even if you could， that still may not make any difference， thanks to how gambling is experienced.

對賭博而言，情況并非如此。賭博是一種行為，而不是一種物質。只要一個人有錢，并且可以自己做主，就很難阻止他去賭博。即使能阻止，也可能起不到什么實際作用，因為賭博的體驗方式與藥物成癮不同。

The nature of gambling means it isn’t experienced as a direct ‘stimulation = reward’ process， the sort that applies to drug taking and underlies the fundamental learning processes of classical conditioning （a key aspect of how addictions take hold in the first place）.

賭博的本質意味著它并不是一種直接的“刺激=回報”過程。“刺激=回報”過程適用于吸毒，可構成“經典條件反射”（在成癮行為形成初期起關鍵作用）這種基本學習過程的基礎。

Such relatively simple processes can also be simple to unlearn. If the stimulation stops producing a reward， then the association undergoes ‘extinction’ in the brain. Do this with the source of an addiction and it loses its power over you. Due to the profound complexity of the human brain， achieving this is rather difficult， but it at least provides something to work toward.

這種相對簡單的過程也可以很容易就忘掉。如果刺激不再產生回報，那么兩者之間的關聯就會在大腦中“消失”。掐掉成癮的源頭，它就會失去對人的控制。由于人腦深邃復雜，實現這一點相當困難，但至少提供了一些努力方向。

Consider this， however. If an alcoholic found that only one random drink in 20 contained any alcohol， while others made them nauseous， it would presumably become a lot easier to kick the habit. But that doesn’t work with gambling， because that’s already how gambling is experienced.

但再想想這個問題。如果一個酒鬼發現20杯飲料中只有一杯隨機含有酒精，而其他飲料惡心得讓人想吐，那么該酒鬼成功戒酒的可能性會大得多。可是，這個方法對賭博不會起作用，因為賭博本身就是碰運氣。

The rewards of gambling occur via a variable reinforcement schedule. You never know when you’re going to win and losing is unavoidable. But as long as you win often enough， you keep at it. And an addiction to the behaviour occurs.

賭博的回報是通過可變的強化程式來實現的。你永遠不知道何時會贏，而輸是不可避免的。但只要你經常贏，而且贏的次數足夠多，你就會堅持下去，然后就會對這種行為上癮。

Knowing the negative outcomes of gambling is already a part of the process. It’s like trying to treat an alcoholic by making them pay for their own drinks; they invariably already are.

了解賭博的負面結果已經成為上癮的一部分。這就像試圖通過讓酗酒者自己付酒錢來使他們戒掉酒癮，而他們本來就是自己花錢買酒。

These are just some of the reasons gambling addictions are such thorny problems to tackle， medically. That means it’s imperative to work on reducing exposure to gambling and the occurrence of addictions in the first place. We’ve got to even the odds somehow.

以上只是從醫學角度說明，賭博成癮為何如此棘手。這意味著，必須首先努力減少賭博現象并盡力防止賭博成癮的發生。我們必須去改變。

（譯者單位：上海工程技術大學外國語學院）