When the Stakes Turn Toxic

Anyone who’s bought a lottery ticket or played bingo has gambled. Gambling is any game of chance in which money changes hands. It’s common in most cultures around the world. Many people enjoy gambling as recreation without causing harm to themselves or others. Yet some people can’t control their impulse to gamble, even when it takes a terrible toll on their lives.         

For these gamblers and their families, researchers have been making progress in several areas. Scientists are learning why people have problems with gambling: how common it is, what goes on inside the gambler’s brain, which is at risk and what kinds of treatment can help.

Problem gambling is defined by some researchers as gambling that causes harm to the gambler or someone else, in spite of a desire to stop. Between 2% and 4% of Americans struggle with this condition. Problem gambling can progress to a recognized psychiatric diagnosis called pathological gambling.

Pathological gambling may affect from 0.4% to 2% of Americans. “Pathological gambling comes with a constellation of problems that contribute to chaos,” says Dr. Donald Black of the University of Iowa. “It’s associated with worse physical health, excessive smoking, excessive drinking, not exercising, not seeing primary care doctors and worse dental care. It also fuels depression, family dysfunction, crime, bankruptcy and suicide.”

Together, pathological and problem gambling may affect up to 5% of Americans. That number may rise, though. Laws in many states are creating more options for legal gambling, and internet gambling is becoming more common.

Still, gambling is often done in family settings, condoned or encouraged by parents. And the younger you start, the more likely you are to get into trouble later on. From 3% to 8% of adolescents have a problem with gambling.

Dr. John Welte of the University of Buffalo has found that, across the lifespan, gambling problems are even more common than alcohol dependence. They are also much more common in males, in young people, and in people who live in relatively poor neighborhoods. “That’s not true of the prevalence of alcoholism,” says Welte. “Alcoholism is much more democratic. So think about motives for gambling. People are hoping that winning will improve their lot. That makes them more vulnerable to developing a gambling problem.”

In a study of mostly African-American inner-city youth, Dr. Silvia Martins of Johns Hopkins University has found that about 15% have some form of problem gambling. Most at-risk were adolescents and young adults who began showing symptoms of depression at age 12. They were highly impulsive, although not hyperactive or aggressive. As the African-American boys developed into their teens and early adulthood, gambling appeared to be a separate risk factor for early fatherhood and criminal arrest.

“We are following up with these inner-city kids every single year as they enter adulthood,” says Martins.

But why is gambling irresistible to some folks and not others? Using advanced imaging techniques, Dr. Alexander Neumeister of Mount Sinai School of Medicine looked at the brains of people with gambling problems and alcohol problems. He measured the number of special receptors involved in regulating impulse control and other factors.          

“A key feature of addiction is impaired impulse control,” says Neumeister. “Abnormal function of the forebrain leads to reduced tolerance to waiting.” The resulting impatience may cause people to act without considering the consequences. “Our imaging clearly points toward the importance of impaired forebrain function in addiction.”

Pinpointing areas in the brain’s reward center, Neumeister’s team found that people with alcohol addiction and gambling problems show different functioning of these special receptors compared to healthy people. The differences were related to the severity of addiction. Other researchers are trying to develop drugs that could treat the affected areas.

Talk therapy can also help. Dr. Nancy Petry at the University of Connecticut Health Center works with pathological gamblers and people seeking treatment for drug use disorders. Gambling problems arise in about 10% to 20% of substance abusers. Petry compared the use of different types of talk therapy, including very brief interventions and cognitive-behavioral therapy CBT. CBT teaches people how to think differently about problems and then act on that knowledge.

“We found very brief interventions and CBT were effective in reducing gambling and gambling-related problems,” Petry says. “There was a significant improvement relative to usual care or standard forms of treatment like Gamblers Anonymous [a 12-step program].”

Anybody can have a gambling problem, and no one should feel ashamed or be afraid to seek treatment. “Pathological gambling is a medical disorder, not a sin or a vice,” says Dr. Carlos Blanco of Columbia University and the New York State Psychiatric Institute. “There is no stereotype. The main predictor of outcome is really motivation.”

In other words, what counts most is a strong drive or desire to take action. Blanco offers gamblers motivational interviewing, which helps them explore their mixed feelings about trying to quit gambling. This primes them to be ready and willing to begin CBT. Using both therapies together can be very effective.

If you have concerns about your gambling, ask for help. Your health provider can work with you to find the treatment that’s best for you.

Poker Texas Holdem

Texas Holdem

At the beginning of a new game, each player is dealt two cards face down. (Hole Cards)

Each bet of the first two rounds of betting is set at the lower limit of the stakes structure. For example in a $5/$10 game, all bets and raises are $5 for the first two rounds (after hole cards are dealt and once the flop is spread in center of table).

The last two rounds of betting (turn card and river) are set at the higher limit of the stakes structure. For example in a $5/$10 game, all bets and raises are $10 for the last two rounds.

One bet plus three raises (four total bets) are the maximum amount of bets allowed per betting round. This would consist of (1) a bet, (2) a raise, (3) a re-raise, and (4) a cap. The term cap is used to describe the 3rd raise in a round since betting is then capped and cannot be raised anymore. Once any player has made the third raise (capped the pot), then players will have only the option of calling or folding.

Check-raising is allowed in all online poker games.

Dealer Button
In order to designate which player is the theoretical dealer in Texas Hold em games, a round disk is used. This disk is called the dealer button or simply "the button".

After each hand is completed, the button moves clockwise to the next active player and this player will be considered to be the dealer, and will act on his/her hand last on each betting round. This is also termed playing the button for that game.

Blinds
The player to the left of the button is first to receive a card and is required to post a small blind. The small blind is equal to half the lower limit bet rounded down to the nearest dollar. The player to the left of the small blind is required to post the big blind. The big blind is equal to the lower limit bet. These bets are referred to as blinds because players must post them before the dealer deals any cards to the players. These blinds are similar to the ante that is required in other games such as 7-Card Stud.

Both the small and the big blinds are considered live bets. They have the option of calling, raising or folding when the betting action comes back around to their position. After the flop and after each subsequent betting round, the first active player left of the button is first to act.

When players first sit down to play, they will be required to post the equivalent of the big blind only once or they have the option to "sit out" until it is their natural turn to post the big blind. This rule is in place to ensure game fairness to all players. The rule prevents the possibility of players entering games in late position and then leaving before they are required a post the big blind.

HOW TO PLAY
The dealer deals players their own two private cards face-down.

First betting round

The dealer spreads three-community board cards face-up on the table. This is commonly called "the flop".

Second betting round

The dealer turns over a fourth board card face-up commonly called "the turn card".

Third betting round

The dealer turns over one final community board card commonly called "the river card".

Fourth and final betting round

Players show their hands. This is commonly called "the showdown".

At the showdown, players may use a combination of both, one, or none of their hole cards to make their best five card hand:

If a player uses both of their hole cards, they will use three of the community board cards; or one hole card and four of the five board cards; or all five board cards, which is commonly called "playing the board" betting.

Poker Crazy Pineapple

Crazy Pineapple

Crazy Pineapple Poker is played with a standard 52-card deck. Blinds are posted by players who sit in consecutive clockwise order from the button. Action is initiated on the first betting round by the player to the left of the person who posted blind clockwise from the button. The blinds act last on the first betting.

All players receive three cards dealt face down (hole cards) as their initial hand. The first round of poker betting occurs. Check and raises are permitted. Three cards are turned face up in the middle of the board simultaneously (flop). These board cards are community cards and available to all players. The second round of betting occurs. At this time poker players choose to keep two of their three cards hole cards from their initial hand and discard the third. The next two board cards are turned up one at a time with a round of betting after each card. After the final round of poker betting has been completed, a player may use any combination of five cards (for example, one hole card and four from the board, etc.) to determine their best hand. A player may use all of the board cards (playing the board). The winning poker hand must show both hole cards face up on the table. The best five-card poker hand wins the pot. In the event of a tie, the pot is split equally.