Addiction (Psychology)

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    Sports Betting Reveals the Addiction in All of Us

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    When we think about any addiction, we tend to focus on people who are utterly consumed by it — those whose lives are visibly falling apart. Yet gambling challenges our usual assumptions about addiction and risk, as its harms extend far beyond the most severe cases.Consider a young man from my therapy practice, a former college athlete, who isn’t bankrupt or in crisis but feels stuck in a cycle of unhealthy online sports betting. He repeatedly deletes the betting app from his phone, only to reinstall it days later at the prompting of a well-timed email, a group bet with friends or simply the ads plastered across every sports arena. He does fine at work and mostly keeps to the dollar limits he sets, but his internal preoccupation, restlessness and chasing of losses just feel bad. He wouldn’t call himself addicted, but he doesn’t feel healthy, either. At the very least, he has the creeping sense that he’d feel better if he put his attention and energy toward something more meaningful.Serious gambling addiction is devastating. Beyond financial ruin, it increases the risk of physical health problems, domestic violence and family rupture. Every year, 2.5 million American adults suffer from severe gambling problems. Many suffer invisibly, silently wagering away their lives on cellphones, perhaps in the very same room as their family and friends.These severe cases demand attention, but focusing only on them obscures something important. As a physician and someone in recovery from alcohol and stimulant addiction myself, I’m concerned by how we have been conditioned to see addiction in all-or-nothing terms. Beyond the millions of Americans who meet the criteria for gambling disorder, five million to eight million more have a mild to moderate gambling problem that still affects their lives — like my patient. Since the federal ban on sports betting was struck down in 2018, sports gambling in the United States has exploded, with annual wagers now approaching $150 billion.Today’s surge of sports betting — supercharged by technology and unfettered industry practices — shows how everyone can struggle with self-control to varying degrees. No longer a simple matter of putting money down on which competitor will win, modern technology has transformed sports betting into a high-speed, continuous stream of wagers throughout the game. For Sunday’s Super Bowl, people can place bets on things from the result of the coin toss to the yardage of the next drive, from Kendrick Lamar’s halftime guests to how many times Taylor Swift is mentioned.Online gambling companies collect troves of personalized data to guide betting variables and marketing to match each user’s patterns and preferences. (The Athletic, which is owned by The New York Times, has a partnership with BetMGM, online sports betting and gaming company.) Subscription plans and automated deposits further erode the friction between impulse and action.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      A Guy I Know Had a Liver Transplant. Now He’s Boozing Again.

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      The magazine’s Ethicist columnist on how to support someone with an addiction problem.My significant other has a friend who is a longtime alcoholic, while also being intelligent, entertaining and conniving. For example, he used to tell his wife he was going to the gym and then head to the bar; before returning home, he’d dampen his clothes in the bathroom to make it seem as if he’d gotten a good sweat on. He was off the radar for a bit, and then we learned he had a liver transplant. After that, he had an episode of hepatic encephalopathy, a brain disorder caused by liver dysfunction. It seems the doctors knew he was still drinking but gave him the new liver anyway and counseled abstinence. A few parties later, he was sneaking vodka, gin and whatever else was around. He lies to everyone and has made his guy friends vow not to tell his wife about his drinking. They’ve made a meager attempt to confront him, only to be assured that he just fell off the wagon and would be good. Just don’t tell the wife!I’m appalled that they’re going along with this. There are a couple of ethical issues here. First, who should decide whether someone is entitled to a transplant? Some hospital systems deny a liver transplant to patients who continue to drink alcohol, and other hospitals don’t. Second, do the friends have an obligation to tell this man’s wife that he’s still drinking? She could insist he leave the house and go to rehab, in which case he might have a chance of living long enough to see his children get married. Some additional context: A friend of mine died waiting for a liver transplant. I am also the child of a lifelong alcoholic. — Name WithheldFrom the Ethicist:There’s more than one morally defensible way of allocating donor organs. In the United States, as in Western Europe, the system emphasizes equity and basically gives priority to patients with the greatest need. An approach that focused instead on efficiency — on getting the maximum use out of donated livers, as measured by ‘‘quality-adjusted life years’’ — might give an edge to people who were younger and otherwise healthier and might work against low-income and minority populations.Organ allocation in the United States is governed by the Organ Procurement and Transplantation Network (O.P.T.N.), whose policies determine the order in which deceased-donor organs are offered; they do not, however, dictate medical practice. So it’s up to a medical center to decide whether or not transplant candidates with alcohol-related liver disease are to abstain from alcohol for some period — six months having long been a typical sobriety window. Some studies indicate that carefully selected patients who aren’t subject to a sobriety window can do just as well as those who are (though the data is hard to interpret because of the ‘‘carefully selected’’ part). And if your drinking has caused a severe case of acute hepatitis that doesn’t respond to medical treatment, you probably won’t survive a six-month waiting period. So the trend seems to be away from requiring an extended interval of abstinence.The point is that the current system for allocating this scarce resource is morally legitimate, whatever trade-offs it may entail; its architects are perfectly aware that many liver recipients will not succeed in refraining from heavy drinking afterward. The fact that this longtime alcoholic has returned to his old habits is distressing. It doesn’t mean that the system isn’t functioning the way it’s meant to.One thing that transplant centers may try to determine is whether patients with an alcohol problem have social networks that could help them stay sober. This brings us to your second question. This fellow’s friends weren’t looking after him when they agreed to uphold this boozy bro code and keep mum. He doesn’t want to die, but he’s drinking himself to death, which means that, at least in this key area, he lacks the capacity for rational decision-making. In a situation like that, it’s more important to attend to his interests than to respect his autonomy. If there’s a chance that his life can be extended by successful management of his alcoholism, and if discussing the problem with his wife will help, thoughtful friends would do just that.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      How Biden Changed His Mind on Pardoning Hunter: ‘Time to End All of This’

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      The threat of a retribution-focused Trump administration and his son’s looming sentencings prompted the president to abandon a promise not to get involved in Hunter Biden’s legal problems.A dark sky had fallen over Nantucket, Mass., on Saturday evening when President Biden left church alongside his family after his final Thanksgiving as president.Inside a borrowed vacation compound earlier in the week, with its views of the Nantucket Harbor, Mr. Biden had met with his wife, Jill Biden, and his son Hunter Biden to discuss a decision that had tormented him for months. The issue: a pardon that would clear Hunter of years of legal trouble, something the president had repeatedly insisted he would not do.Support for pardoning Hunter Biden had been building for months within the family, but external forces had more recently weighed on Mr. Biden, who watched warily as President-elect Donald J. Trump picked loyalists for his administration who promised to bring political and legal retribution to Mr. Trump’s enemies.Mr. Biden had even invited Mr. Trump to the White House, listening without responding as the president-elect aired familiar grievances about the Justice Department — then surprised his host by sympathizing with the Biden family’s own troubles with the department, according to three people briefed on the conversation.But it was Hunter Biden’s looming sentencings on federal gun and tax charges, scheduled for later this month, that gave Mr. Biden the final push. A pardon was one thing he could do for a troubled son, a recovering addict who he felt had been subjected to years of public pain.When the president returned to Washington late Saturday evening, he convened a call with several senior aides to tell them about his decision.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Jill Stein’s Third-Party Candidacy

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      More from our inbox:Harris’s AdsDrug-Free TreatmentsRegretting Email, and Other Modern MusingsJill Stein, the Green Party’s candidate for president, after a campaign event in Dearborn, Mich., earlier in October.Nic Antaya for The New York TimesTo the Editor:Re “She’s Still Running for President, No Matter Who Asks Her to Stop” (front page, Oct. 20):I just came back from the grocery store in Philadelphia, where I live. On the street corner opposite the store was a sign that said something like “Demand more from Harris or I am voting for Jill Stein.” At the bottom it said the sign was from the progressive cause.Make no mistake: Anyone who votes for Ms. Stein because they think Kamala Harris isn’t progressive enough is really voting for Donald Trump. This is Pennsylvania, for heaven’s sake, which many believe is the most critical swing state. And where the race is thought to be very, very close.If progressives are really committed to their cause, they can’t vote for Ms. Stein in Pennsylvania. Massachusetts maybe — where it doesn’t matter. But not here. (Progressives can’t really think they will get closer to their policy goals with Donald Trump!)We can’t afford another Florida 2000, when the votes for Ralph Nader may have cost Al Gore the election. The stakes are too high.Stephen M. DavidsonPhiladelphiaTo the Editor:The platform of the Green Party includes as one of its “four pillars”: “Ecology: The human cost of climate change is too high. We need to get off fossil fuels and on to renewable energy.”The candidacy of Jill Stein, the Green Party nominee, could hand Donald Trump the presidency. Mr. Trump, in his stint in the White House tweeted, “The concept of global warming was created by and for the Chinese in order to make U.S. manufacturing non-competitive.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      California Drug Clinic Operator Convicted in $3 Million Kickback Scheme

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      Casey Mahoney, 48, of Los Angeles, illegally paid “body brokers” to lure clients, a federal jury found.A California man who operated addiction treatment facilities in Orange County was convicted this week of paying nearly $3 million in illegal kickbacks for referrals of patients to his facilities, according to federal prosecutors.From at least October 2018 until December 2020, the man, Casey Mahoney, 48, of Los Angeles, paid about $2.87 million to “so-called ‘body brokers’” who gave thousands of dollars to patients to coax them into Healing Path Detox L.L.C. in Huntington Beach and Get Real Recovery Inc. in San Juan Capistrano, two treatment centers Mr. Mahoney operated, the U.S. Attorney’s Office for the Central District of California said in a statement on Friday.Some of the money that the body brokers gave to patients was used by the patients to buy drugs, the department’s statement said.After a nine-day trial, a federal jury in Los Angeles found Mr. Mahoney guilty on Wednesday of one count of conspiracy related to offering illegal remunerations for patient referrals, seven counts of illegal remunerations for patient referrals and three counts of money laundering, prosecutors said. He was acquitted on one count of aiding and assisting the preparation of a false tax document.The money-laundering charges, the most serious on which Mr. Mahoney was convicted, each carry a maximum sentence of 20 years in prison. Sentencing is set for Jan. 17, 2025.Treatment facility operators may pay a group like a marketer or an advertiser to promote their services to patients. But the Eliminating Kickbacks in Recovery Act of 2018 prevents the operators from paying body brokers kickbacks based on how much revenue the patients they referred brought in, as Mr. Mahoney did, according to the indictment.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Matthew Perry and the People Who Prey on Addicts

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      Deep into my love affair with cocaine, I sat in the living room of a neighbor’s house with several other people, waiting for the mirror with the coveted white lines on it to come my way. It’s why we were all there — to buy coke and get high during the transaction. The woman sitting nearest to me yelped in pain as she snorted the lines through a white plastic straw. She explained that she’d burned a hole through her septum from doing coke. Then she shrugged and said something about having to get it repaired at some point.There was a moment, as the mirror came to me and I bent over it, seeing my reflection beside the lines I so desperately wanted, when I saw clearly the cost of this addiction. But that brief moment was swallowed by the desire that propelled me, her and everyone else in that room. I watched as our host — our dealer — escorted her to the door, handed her the small zip-lock bag containing the love of her life, and took a wad of cash in exchange. I’m quite sure he never had a moment of hesitation or guilt.The recent charges made in connection with the death of Matthew Perry sent these memories hurling back at me. It’s no surprise to encounter the callousness, the greed of dealers who know with expert precision how to prey on addicts. But in Mr. Perry’s case, we’ve seen a murkier area — a messy middle ground where people apparently start out thinking they’re helping but end up enabling and eventually hurting. Two doctors and Mr. Perry’s personal assistant have been charged, in addition to two other people. Maybe I’m being generous, but I’m assuming that the doctors, at least at one time, respected the pledge to “do no harm.” Yet it was one of the doctors who sent the text that read, “I wonder how much this moron will pay.” Matthew Perry ended up paying $55,000 for roughly 20 vials of ketamine. I have no idea what the market price for ketamine is, but $55,000 seems a bit steep.Matthew Perry was not a moron. He was a man in a dark tunnel, a tunnel that echoes with desperate desires he had tried, but in the end failed, to control. I have seen some in that tunnel who understand, with chilling cruelty, how to prey on addicts and have no pangs of conscience about doing so. They know that rational thought and instincts of self-preservation get drowned out by the raging desire to feel a drug coursing through one’s body.When I worked in a restaurant, I could tell intuitively when customers had coke on them. I was almost always right. I went out to the parking lot and sat in cars with total strangers just to do a line. As stupid as that was, I’m not a moron either. I was led by an addiction that blindfolds you and shoves you in the direction of only one thing — the drug you crave.Did some of the people charged in connection with Mr. Perry’s death start out rationalizing? Saying things like, “We’re helping to lessen his pain” or “If we don’t give this to him, he’ll get it somewhere else?” However they started out, they seem to have ended up in the same cold terrain as the dealers. When Matthew Perry died, a text went out between two of the five people charged saying to delete all previous texts.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Veteran Homelessness Was Cut by Half. Is a Broader Solution Possible?

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      After two years in the Air Force and decades on Skid Row, Steve Allen was spending his senior years living in his car. John Sullivan, who joined the Army after seeing the film “Patton,” slept on his son’s couch. Home for Babs Ludikhuize, an Air Force veteran recovering from domestic violence, was in psychiatric care.Now all three have comfortable apartments with subsidized rents, and they embody what many analysts call the greatest success in homelessness policy — the decline in homeless veterans.Since 2008, Congress, with bipartisan support, has spent billions on rental aid for unhoused veterans and cut their numbers by more than half, as overall homelessness has grown. Celebrated by experts and managed by the Department of Veterans Affairs and the Department of Housing and Urban Development, the achievement has gained oddly little public notice in a country in need of broader solutions.Progress in the veterans program has slowed as rising rents displace more tenants and make it harder to help them regain housing. But while homelessness among veterans rose last year, the increase was smaller than other groups faced. Admirers say the program’s superior performance, even in a punishing rental market, offers a blueprint for helping others and an answer to the pessimism in the debate over reducing homelessness.“It is the best initiative on homelessness that the federal government has ever developed,” said Philip F. Mangano, who helped launch the program under President George W. Bush. “The best. By far. If we can do it for veterans, we can do it for others.”No place illustrates the hard-fought progress more than Los Angeles, which serves more homeless veterans than any other city and has gravity-defying rents.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Hunter Biden’s Conviction, and a Family’s Pain

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      Readers discuss addiction, call for compassion and praise how the president has supported his son.To the Editor:Re “President’s Son Is Found Guilty on Gun Charges” (front page, June 12):President Biden lost his first wife and daughter in a car accident. He lost his son Beau to brain cancer. Hunter Biden, his other son, has just been found guilty of felony charges involving gun possession.We live in a painfully polarized time. But I would argue that, regardless of party affiliation, compassion and empathy are warranted in acknowledging our shared humanity. While pundits will no doubt turn their focus to political fallout, we should not lose sight of the big picture: These are real people, with real lives, and real suffering.Larry S. SandbergNew YorkThe writer is a psychiatrist.To the Editor:Re “One Thing Everyone Has Missed About Hunter Biden’s Case,” by Patti Davis (Opinion guest essay, June 12):Addiction is a disease, and neither intelligence, education or great family support can prevent it. Such things also do not prevent cancer, mental illness, Parkinson’s or any other disease.Hunter Biden fell prey to addiction, and as a result made bad choices that got him into trouble and have troubled his loving family to this day, even though he has been sober for a while, and hopefully will continue to be — although prison is not a good environment for an addict trying to stay sober!If Hunter Biden weren’t the president’s son, he likely would not have even been on trial for something he did that thousands of addicts do in our gun-loving society, and get away with.Can we ever get away from politicizing everything? Not in the current divisive climate.Patti Davis’s article is right on! And beautifully written.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      In Hunter Biden Trial, Focus Turns to the Biden Women

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      The women called to testify have at different times tried to support a man whose history of addiction continues to hit them with shrapnel.Naomi Biden Neal, Kathleen Buhle, Jill Biden and Hallie Biden attended Hunter Biden’s trial this week.Haiyun Jiang for The New York TimesOne by one, the women drifted into the courthouse: The wife. The ex-wife. The daughter. The sister-in-law who, through the fog of tragedy and drug abuse, ended up an ex-girlfriend.Once inside the courtroom, they locked their eyes past the many strangers who watched them — people who wondered if they would break down, or say the wrong thing. If they would cry.Hunter Biden is the one on criminal trial, staring down gun charges. But the spectacle in the courtroom has forced the Biden women into an uncomfortable spotlight.In the family, public life has often revolved around the men. The women called to testify had, at different points, tried to support and protect the one who was the troubled husband, father and son — and whose ruinous history of addiction continues to hit them with shrapnel. The women who didn’t speak sat in the courtroom, playing parts of nurturers and sentinels.The pain of this responsibility was written on the face of Hunter Biden’s eldest daughter, Naomi Biden Neal, who testified on his behalf on Friday.“He seemed great,” a nervous-sounding Ms. Biden Neal, dressed in black with her hair pulled back, told the court on Friday. “He seemed hopeful.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More